# H&P's for hospital outpatient procedures



## stone6401 (Nov 23, 2011)

Hi all,

I have an E&M question for you.  My EP doc sees patients in the office to evaluate their symptoms, then decides to do an ablation at the hospital in a few weeks.  When they show up for the outpatient procedure at the hospital, he does an H&P that morning.  Is this billable?  One one hand, he already made the decision.  On the other hand, maybe he's making sure nothing's changed with the patient since the last visit was a few weeks ago. 

Thoughts?

Thanks!!!  And I hope everyone has a blessed Thanksgiving tomorrow!!!


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## mdoyle53 (Nov 23, 2011)

The H&P on the day of the procedure is inclusive in the procedure.  If there is concern about the patient, he could do a pre-op 2-3 days before and bill for it or send the patient to a PCP for a pre-op decision.  However, there needs to be medical necessity.


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## TonyaMichelle (Nov 23, 2011)

Physicians cannot bill twice for the E/M service that he already used to determine his medical decision for surgery, however, if he happen to come across a new medical decision for another procedure that is distinct or independent from other services performed on the same day, he can append modifier -59 to the secondary procedure or, if he decides to do additional procedures that are related to the primary procedure, he can use modifier -51 for multiple procedures if those procedures are not components of another procedure or add-on codes.

Hope this helps and Have a Happy Thanksgiving


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## gski (Nov 30, 2011)

So should the Dr bill the office visit with the decision for surgery only??  My EP Dr will make the decision for surgery at a office visit, then the procedure is scheduled within the next couple weeks, and will dictate the H&P for the admit records at the hospital.  The Dr will review the dictated H&P at admission to verify if anything has changed, and note any changes found or that it is unchanged.  

What about when the procedure (like 93650 for an ablation) has "000" global days?  Is it correct to bill the admission instead of the office visit that happened a few days prior?  Or can both be billed?  HELP!

Thank you!


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## ajs (Nov 30, 2011)

gski said:


> So should the Dr bill the office visit with the decision for surgery only??  My EP Dr will make the decision for surgery at a office visit, then the procedure is scheduled within the next couple weeks, and will dictate the H&P for the admit records at the hospital.  The Dr will review the dictated H&P at admission to verify if anything has changed, and note any changes found or that it is unchanged.
> 
> What about when the procedure (like 93650 for an ablation) has "000" global days?  Is it correct to bill the admission instead of the office visit that happened a few days prior?  Or can both be billed?  HELP!
> 
> Thank you!



Yes, only bill the office visit that established the decision for surgery, the dictated H&P is just part of the documentation for that office visit. Global 0 days means everything done the day of the procedure is covered under that procedure code, the admit in included in that.  But you can bill for visits post op.


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## gski (Dec 1, 2011)

Thank you for clarifying that Arlene!


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