Once a patient has completed their radiation therapy, (and/or Brachytherapy, implant/HDR) the radiation oncologist will instruct the patient to return to the office for a follow-up visit. Usually, this is a period of approximately 3-6 months.
However, there are occasions when the patient will have to return within the 90-day global period that HCFA has set. Side effects such as erythema of the skin (redness), dry throat, declined conditions of the patient are just a few to mention.
The rule of thumb for Medicare payers is if a follow-up is scheduled within the 90 day of the patient’s last visit date, YOU DO NOT BILL MEDICARE for that visit. It is incorporated within the last week of treatment. The only exception to that rule is that you may bill the follow-up code for other insurance carriers! That doesn’t mean that all will pay. Some insurance carriers follow the Medicare guidelines and will not pay.
The following is a brief explanation from Cancer Care Network Users Guide 1998, on follow-up codes written by, Dr. Carl Bogardus:
99211
- FU Visit - Simple
- The Presenting problems are minimal
- Average encounter time is 5 minutes
99212
- FU Visit – Expanded
- Evaluation requiring a problem focused history and physical examination with straight forward decision making
- Average encounter time is 10 minutes
99213
- FU Visit – Detailed
- Requires an expanded problem focused history and physical examination with medical decision making of low complexity
- Minimal testing required
- Average encounter time is 15 minutes
99214
- FU Visit – Comprehensive
- Requires a detailed history and physical examination with medical decision making of moderate complexity
- Multiple diagnoses must be considered
- Coordination of care with other physicians may be necessary
- Average encounter time is 25 minutes
99215
- FU Visit – High Complexity
- Requires a Comprehensive History and physical examination with medical decision making of high complexity
- Testing may be extensive and coordination of care with other providers may be necessary
- Average encounter time is 40 minutes
BILLING TIP
Always remember that if the Radiation Oncologist orders a test whether it is a CT Scan (76370) or fibro-optic laryngoscope (31575), a 25 modifier is needed on the follow-up code!
Do not bill a follow-up code for Medicare if it is within the 90-day global period from the last patient visit. You may not use a modifier to unbundle this procedure if done within the global period.
Bill this procedure for non-Medicare carriers.
