Friday, June 14, 2013

For post-op disease counseling, consider V58.42


There is this patient with a prostate cancer diagnosis who had an office visit during the post op period to discuss treatment options (not for surgical follow up). So can I bill for this office visit during the global period, and what diagnosis code should I use to indicate that the service was unrelated to surgery?


Well, yes you can separately bill an office visit for treatment counseling during the post-op period. You should report the underlying diagnosis -- 185 (Malignant neoplasm of prostate).


The global package doesn't not include treatment directed at the underlying disease process even for the most conservative payers such as Medicare.


The Claims Processing Manual (Internet only manual 100-04) section 40.1B lists "treatment for the underlying condition or an added course of treatment which isn't part of normal recovery from surgery" as a service not covered in the global surgical package.


Keep in mind: Add modifier 24 (Unrelated E&M service by the same doctor during a postoperative period) to your evaluation & management visit to indicate that this visit is unrelated to the surgical procedure. This'll guarantee payment for the office visit within the global period of the surgery.


Counseling on treatment choices and prognosis is not normal recovery from surgery, however is care directed at the underlying disease process.


Check diagnosis: Some payers might warrant an additional diagnosis to further support the reason for the encounter. For example, V58.42 (Aftercare following surgery for neoplasm), V58.76 (Aftercare following surgery of the genitourinary system, NEC), or V65.8 (Other reasons for seeking consultation) might help establish the separate nature of the encounter. Get in touch with your major payers and see how they want you to report these services so that you can get paid for proper additional services during the global period.







77071: A Small Status-Indicator Change Could Cost You $46 Per Claim

radiology coding,medical coding resource


You never know what every new quarter will unfold as far as Medicare updates are concerned. This month you need to ensure your practice is up to speed on physician fee schedule news.


New: The bilateral surgery indicator for 77071 (Manual application of stress carried out by doctor for joint radiography, including contralateral joint if indicated) has changed from three (The usual payment adjustment for bilateral procedures does not apply) to 2 (150 percent payment adjustment does not apply).


While the effective date is January 1, the implementation date is April 4, 2011. This means that the changes are retroactive to January 1 this year. But then your carrier's deadline for implementing the changes is April 4.


Previous way: '3'offered payment for two sides


77071 used to have a bilateral indicator of 3. As per the Medicare Physician Fee schedule, a bilateral surgery indicator of three basically means that when you code the procedure as bilateral, the carrier will pay you separately for each side.


Indicator three rule: When you code both sides on the same date, Medicare will base the payment for each side on whichever is lower -- the actual charge for each side or 100 percent of the fee schedule sum for each side. The rule holds true regardless of how you report the bilateral service. (say for instance using modifier 50 (Bilateral procedure), modifiers RT and LT or two units.


What's more, Medicare's policy for the three indicator is: "If the procedure is reported as a bilateral procedure and with other procedure codes on the same day, figure out the fee schedule amount for a bilateral procedure prior to applying any multiple rules.


Just-in way: '2'tells you 1 code includes Bilateral Service


Since code 77071 now has a 2 bilateral indicator, you will need to be sure your reimbursement expectations are in line with the official fee schedule.


Indicator 2 rule: When the agency labels a code with a 2 bilateral indicator, relative value units are already based on the procedure being carried out as a bilateral procedure, as per fee schedule documentation.


Consequently, if you report the procedure a couple of times on the same date, Medicare will base payment on the lower of:





  • The actual fee for both sides
  • Or 100 percent of the fee schedule amount for a single code.


    Impact of the change: This could be a big drop for practices that were collecting twice the reimbursement and now will get no payment adjustment. But then since the descriptor refers to inclusion of the contralateral joint, it would be difficult to dispute the fact that the code is inherently bilateral.


    Good tidings: Although the change is retroactive to January 1, Medicare is not requiring contractors to search their files to adjust claims they have paid already. But then contractors will adjust claims if you bring them to their notice.

  • Podiatry Billing: Give these modifier 24 myths a miss

    Podiatry billing guidelines: You need to train eyes on podiatrist's documentation and not the appointment book.


    In order to seal your payments for services your podiatrist carries out after a major procedure while you are still billing in the global period of the procedure, you need to be well-versed with the ins and outs of modifier 24.


    Here are some myths relating to this modifier that you can stay away from:


    Modifier 24 is applicable to any service done in the post-op period – this is a no.


    You should add modifier 24 to an appropriate E/M code when an evaluation & management service takes place during a postoperative global period for reasons not related to the original procedure. This modifier tells the payer that the surgeon is treating the patient for a new problem. As such, the plan shouldn't include the evaluation & management service in the previous procedure's global surgical package.


    This modifier is only for use on E/M codes and only for use during the post-operative period (10 or 90 days).


    As a rule, you cannot bill separately for evaluation & management related services pertaining to the original surgery during the global period. This surgical package includes routine postoperative care during the global period.


    Scheduled office visit means no modifier 24


    Don't assume you are unable to bill separate services using modifier 24 just because of the fact that a patient was scheduled to visit related to the surgery.


    Here's an example to substantiate this: A patient has a lumpectomy. When the patient comes back in to the office for sutures pathology has found out that the lump turned out to be cancer. As such, the doctor does an extensive E/M service/office visit with the patient to discuss.


    Here, you should be able to use modifier 24 to describe an evaluation & management service not related to the surgery. CPT would always allow this, however even Medicare says that care directed at the underlying disease process is billable separately in the global period.