Wiki Coding followup visits

[AprilSueMadison]

After a biopsy, we generally have the patient come back to the office about 7 days later for bx results. If nothing new is done, as in, the only thing the patient gets are bx results then we should not code it as an office visit correct?

General example -

8/15 (left modifiers off the example case below!)
99202
17110
11100
11101

Then on 8/27 the provider wants to code a 99212 for a new office visit, but the only thing that happens is there is a wound check for healing and bx results. First, even if I thought this was allowed we need a 24 modifier since 17110 has a global of 10 days....BUT I do not think this is allowed and would like some more information to take back to my doctor.

If the patient was checked for a new rash during this office visit, then an E/M code could be used. I feel like I've got a good understanding, but still feel unsure when I go to him and tell him he can't do this.

 

[tsnider]

Hi there; if the patient is coming back truly as a post-procedure follow-up and review of the biopsy results from that procedure and nothing new is addressed or discovered then this would be considered part of the global charge.

 

[Donna T]

You are correct. If the patient is being seen for a wound check and bx results then you would use CPT code 99024 with a $0 charge amount. However, if the patient came in with an unrelated complaint ie. a rash then you'd be the appropriate e/m code with a -24 modifier. Hope that is helpful to you.

Donna

 

[AprilSueMadison]

Yes it is very helpful. Sometimes I just need to write it out and hear someone explain it back to me or agree! Thank you both!

 

[tracyp38]

Question in regards to the follow up visits, If a patient is returning in a week for suture removal/biopsy results, and there is discussion regarding treatment options, does that not qualify for an office visit?

 

[holmes.tammy@sbcglobal.net]

Question in regards to the follow up visits, If a patient is returning in a week for suture removal/biopsy results, and there is discussion regarding treatment options, does that not qualify for an office visit?

Good question, also what if the patient came in for a procedure with a 90 day global period in Aug, came back in Sept. to discuss the results and at that time decision for hysterectomy 58150 was made how would you code that visit? 99213/57?

 

[AprilSueMadison]

To me, this would not qualify for a separate office visit. The patient would have to come in for something completely different, as in a new lesion on their forehead instead of the one they had removed from their arm.

We do not code stitch removal here because it is related to the original procedure. I don't know if that is accurate, I'm still learning this stuff and haven't yet taken my CPCD.

 

[lindalou0259]

Post 11100 visits

Since 11100 & 11101 do not have Post Op periods this is a hard to educate providers on. If anyone knows where documentation is please let us know so we can provide our doctors.
My understanding of this is....pathology reveals further treatment needed, charge for procedures done on followup (ie, 17000, 17004, 11600, etc) only. If the pathology indicates a condition, ie, MF, Psoriasis, etc., and the follow up requires education and treatment of a condition, E&M for level of care should be charged....but MUST be documented as in many cases will have to appeal a denial. However, if the biopsy was just for confirmation of the condition (doc thought psoriasis and began treatment on same day as biopsy and no further treatment was added) this would not justify an E&M of any level.
If follow visit is to explain diagnosis (AK, MM, BCC, etc) and explanation of a variety of treatments for patient to consider and later schedule, you can try submitting a lower level E&M (again, Must be documented showing Medical Necessity).