For Post-op Disease Counseling, Consider V58.42

By Author: erinarticle
Total Articles: 105
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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.


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