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Radiology Coding Alert

Reader Question:

E/M Billing for Delayed Therapy Is Possible

Question: Our radiation oncologist sometimes sees patients for an initial E/M service either a new patient visit or a consultation but doesn't begin therapy for a couple of months. Just before he begins therapy, the doctor re-evaluates the patient and completes a dictation of the patient encounter. Does this constitute a billable E/M service or not? North Carolina Subscriber Answer: Yes, this is a billable service if it is medically necessary for the radiation oncologist to assess the patient's condition after the initial patient evaluation but prior to the beginning of treatment. There are several valid reasons why the doctor may need to re-evaluate the patient before beginning treatment. For example, the patient's tumor volume may have either increased or decreased, or the extent and severity of the disease process may have altered. This visit should be billed with one of the follow-up E/M codes (99211-99215). The level of complexity will be dictated by the extent of service documented in the medical record.

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