Oncology & Hematology Coding Alert

Question: If the patient is seen in the post-operative period for follow-up to discuss the path report and the provider recommends additional treatment (like chemo), is that visit billable outside of the global post-op period with modifier 24? If the provider only reviews the path report, then is that included in the global surgery?

North Carolina Subscriber

Answer: Your oncologist can bill a “where do we go from here” visit whether he orders chemotherapy or not, but his documentation must clearly present this picture. This type of situation is to address and treat the underlying illness and would be separately reportable outside of the global period. You would apply modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) to that E/M visit.

Note: You cannot use selection of any elements that were performed and done as part of routine follow-up care in determining the level of service for this visit.