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Oncology & Hematology Coding Alert

Reader Questions:

Only Code Follow-Up If Unrelated Reason

Published on Fri Feb 22, 2008

Question: Under normal circumstances we cannot bill a follow-up within 90 days of a patient completing radiation therapy. Can we bill a separate service, however, if the patient returns because he has a relapse in disease and needs to discuss his next course of therapy? Illinois Subscriber Answer: How you handle the situation depends on the outcome of the patient's visit. ASTRO (American Society for Therapeutic Radiology and Oncology) guidelines state that follow-up examinations within 90 days of radiation therapy completion are considered to be part of the reimbursement for treatment management; therefore, you cannot bill the follow-up visit separately during this period. If the patient comes in because of a new complaint unrelated to the condition your oncologist just treated, however, you can report the appropriate E/M code from 992xx (Office or other outpatient visit for the evaluation and management of an established patient -)
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