You are watching: Cpt code for follow up visit after surgery
Question: Code 19101 has actually a 10-day global period, which means you cannot bill an E/M for anything regarded that procedure within that time frame. If the patient continues to have follow-up visits exterior the global period, need to we climate report the ideal E/M level?
Example: Patient has an open up breast biopsy on June 15, therefore the global period goes with June 25. The patient then has extr follow-up visits on June 26, July 3, and also July 10. What is the most appropriate means to bill for the three follow-up visits that the surgeon provides outside the global period? does modifier 24 apply?
Answer: You are correct the 19101 (Biopsy of breast; open, incisional) has actually a 10-day worldwide period. You should code each of the medically important office access time (99212-99215, Office or various other outpatient visit because that the evaluation and management of an established patient …) the the surgeon provides exterior the 10-day worldwide period. You do not have to append a modifier.
You do require a modifier, however, once you have actually a patience visit during the an international period that is separate and also distinct native the expected post-procedural follow-up.
Then you need to use comprehensive 24 (Unrelated evaluation and management business by the very same physician during a postoperative period).
Be ready for the insurer to inquiry why therefore many additional post-procedural visits are necessary. Make certain that the ICD-9 coding reflects any kind of complications, together as infection (998.59, Other postoperative infection), that explain the inexplicable volume the follow-up visits.
Caution: Before billing the an initial non-included E/M company on June 26, make certain that extenuating circum-stances did not push the visit into a billable period. For instance, was the 25th a Sunday and also you no have any office hrs until the 26th? Or did her office have actually no visits easily accessible on the 25th or before, therefore the patience was compelled to come in after ~ the worldwide period ended? If scheduling gamed the system, girlfriend should encompass the visit on the 26th in the worldwide period because that 19101.
You have the right to separately bill the ideal E/M level because that the access time on July 3 and July 10.
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If friend don’t want federal auditors to come knocking, it’s more important than ever not come code and also bill services individually if they should be in the worldwide period. But an too many cautious method could hurt your bottom line. Find out the rules and also get all the reimbursement you deserve at this audio conference.