How Do I Bill For Follow-Up Visits After the Global?

Posted on 12. Jan, 2010 by Editor in Coding Challenge

Tip: Make sure the ICD-9 coding & documentation support follow-up visits after the global.

Question: Code 19101 has a 10-day global period, which means you cannot bill an E/M for anything related to that procedure within that time frame. If the patient continues to have follow-up visits outside the global period, should we then report the appropriate E/M level?

Example: Patient has an open breast biopsy on June 15, so the global period goes through June 25. The patient then has additional follow-up visits on June 26, July 3, and July 10. What is the most appropriate way to bill for the three follow-up visits that the surgeon provides outside the global period? Does modifier 24 apply?

Answer …

Answer: You are correct that 19101 (Biopsy of breast; open, incisional) has a 10-day global period. You should code each of the medically necessary office visits (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient …) that the surgeon provides outside the 10-day global period. You do not need to append a modifier.

You do need a modifier, however, when you have a patient visit during the global period that is separate and distinct from the expected post-procedural follow-up.

Then you should use modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period).

Be prepared for the insurer to question why so many additional post-procedural visits are necessary. Make sure that the ICD-9 coding reflects any complications, such as infection (998.59, Other postoperative infection), that explain the unusual volume of follow-up visits.

Caution: Before billing the first non-included E/M service on June 26, make sure that extenuating circum-stances did not push the visit into a billable period. For instance, was the 25th a Sunday and you didn’t have any office...

Tags: 19101, 99212, 99215, E/M, follow-up, global, modifier 24