Wiki Post-Service Work included in E/M

[Brenda Ray]

If a patient returns to the Physician's office to discuss test results i.e., labs, xrays, scans, etc., can the Physician charge an E/M level or is this considered post-service work included in the E/M for the previous visit that prompted the tests?

We see a lot of patients that return to the Oncologist to discuss biopsy results and treatment options i.e., radiation, chemotherapy, etc. Could this be considered counseling and education since treatment options are discussed? If so, can we charge the E/M based on time if greater than 50% spent counseling and educating? OR, is this visit included in the post-service work of the visit that prompted the biopsy initially? The global concept does not apply for 38220, 38221.

Is G0364 still applicable for Medicare billing when aspiration biopsy and core needle biopsy are performed via same incision, same lesion?

 

[OCD_coder]

You can bill if the results of the tests that support additional work of discussing a treatment plan. If just results are given and no treatment plan is discussed, then it is included with the E/M when the test if ordered. It is expected that you would give the results to the patient if you ordered the test - you cannot separate it out and get double reimbursement. Oncology is very complicated in that chemotherapy is complex and takes a great deal of "counseling" to educate the patient on what is going to happen if they decide to do treatment. The doctor will just need to be sure and document time carefully, remember the 3 T's. Total time, total time devoted to counseling, treatment plans (the why of the counseling).

MCR will allow you to bill during postop periods for E/M that is devoted to counseling a patient for chemotherapy. Append a mod-24. This is outside of "normal" follow up care for the surgery. This applies only to doctors that do the surgery and chemo treatment, such as GYN-ONC.

Yes, for Medicare patients you bill the G0364 with the biopsy. They have removed the aspiration from the parent code (38221) and you always bill them together to recieve full reimbursement. MCR has reduced the fee's for both codes so that when you bill them both it would be relatively equivalent to what commercial payor's pay for billing just the 38221.

I hope that helps.