Wiki Radiation Oncology Post-Tx Visits

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MCordero

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Hello-

My question is: what code should we be submitting for post treatment visits? To my understanding, any of the codes that we use do not have global days. So, we should be submitting the proper E&M code. Other sources here are telling me otherwise... that the code is submitted but as a "no charge".

Help would be appreciated. Thank you.



MCordero, CPC
 
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What codes are you using? There are certain codes that do hold a 90 day global, in which case you would just bill the E&M as a no charge in that post 90 day time frame. However, if none of the codes you bill for have a 90 day attached, then I would say you should be able to bill the followup E&M. Check on CMS website for your codes to see if they have a 90 day attached.
 
Post Radiation Therapy EM

Followup exams within 90 days of completion of therapy are considered part of the reimbursement for treatment managment (77427) and are not billed seperately. However, diagnostic tests and certain procedures may be billable. Additionaly, if the patient returns within 90 days presenting with a new or different problem, then the E/Ms may be applied.
 
If a patient comes for her post radiation treatments (normally within 90 days as there is a 90 day global) but the follow up visit is past the 90 days, should patient be charged an E&M. This is her first visit after treatment, just happens to fall past the 90 days. I am thinking patient should not be charged because the follow up visit was included in the management code. Even if she returns past 90 days for her first follow up? Is this correct? I cannot find official documentation concerning this.
 
Annette said:
Post Radiation Therapy EM

Followup exams within 90 days of completion of therapy are considered part of the reimbursement for treatment managment (77427) and are not billed seperately. However, diagnostic tests and certain procedures may be billable. Additionaly, if the patient returns within 90 days presenting with a new or different problem, then the E/Ms may be applied.
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Although this is an old post, can you tell me where you found this? I am getting MCR denials saying an E/M for something unrelated to the radiation therapy is bundled in the radiation therapy codes.
 
andersont said:
Although this is an old post, can you tell me where you found this? I am getting MCR denials saying an E/M for something unrelated to the radiation therapy is bundled in the radiation therapy codes.
Click to expand...

You can find it in the ASTRO Coding Resource:

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