Urology Coding Alert

Question:

Texas Subscriber

Yes, you can separately bill an office visit for treatment counseling during the post-op period. You should code the underlying diagnosis -- 185 (Malignant neoplasm of prostate).

The global package does not include treatment directed at the underlying disease process, even for the most conservative payers like Medicare.

The Claims Processing Manual (Internet only manual 100-04) section 40.1B lists "treatment for the underlying condition or an added course of treatment which is not part of normal recovery from surgery" as a service not included in the global surgical package.

Remember: Add modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to your E/M office visit to indicate that this visit is unrelated to the surgical procedure. This will ensure payment for the office visit within the global period of the surgery.

Counseling on treatment options and prognosis is not normal recovery from surgery, but is care directed at the underlying disease process.

Check diagnosis: Some payers might want an additional diagnosis to further support the reason for the encounter. For instance, V58.42 (Aftercare following surgery for neoplasm), V58.76 (Aftercare following surgery of the genitourinary system, NEC), or V65.8 (Other reasons for seeking consultation) might help establish the separate nature of the encounter. Contact your major payers and see how they want you to report these services so that you can get paid for appropriate additional services during the global period.