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Can an E&M code be billed for discussion of path results during global period?

Terry Posted Fri 21st of December, 2012 14:00:31 PM

My doc keeps insisting that she should be able to bill an E&M code to discuss/counsel a pt on biopsy path results during the 10 day global period. I have searched the Chapter 1 of the NCCI edits and do not find this addressed specifically. The references of what is included in the minor surgical package are related to the care of the surgical wound/procedure itself. Can someone please help - is the answer in writing anywhere?

SuperCoder Answered Fri 21st of December, 2012 20:02:36 PM

It can depend on the documentation a little bit and carrier (if they follow strictly by MCR global rules).
Did the course of treatment change from the surgical procedure? If yes - you can bill a separate E/M with a modifier 24 added. This type of situation happens a lot with oncology physicians that remove a tumor then a new treatment plan is initiated postop as they did not know what kind of cancer the patient had until the surgery.

But if just the findings are given and no change has occured to the treatment plan, then No, a separate E/M would not be billable as the patient would be recovering normally from the procedure.

Per CPT:
“Followup care for diagnostic procedures includes only that care related to recovery from the diagnostic procedure itself. Care of the condition for which the diagnostic procedure was performed or of other co-existing conditions is not included.”

MCR (from the March 2011 Coding Edge)
Medicare’s definition of the global package is broader than the AMA’s, but clearly states, “Services not included in the global surgical package are as follows:
• The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery [procedure];
• Treatment for the underlying condition or an added course of treatment, which is not part of normal recovery from surgery;• Diagnostic tests and procedures, including diagnostic radiological procedures.”

Terry Posted Sat 22nd of December, 2012 13:24:39 PM

Thanks very much for your response and for citing the guidelines that support this. Very helpful!

Terry

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