# History and Physical Billing



## Trendale (Nov 18, 2008)

Hello,
One of the physician's I code for is trying to bill a H&P the day of the surgery. He has already billed a new patient visit tht same day. I did not think we can bill the H&P, I thought it was included in the 90 day surgical package ( The day before and the day of).When is it appropriate to bill for the H&P? Thanks!


----------



## FTessaBartels (Nov 18, 2008)

*Two problems*

First ...
You *cannot *bill both the office visit AND the H&P on the same date of service. CPT tells you to roll all the work done together to determine your level of service for the H&P.

Second ... 
An E/M on the day of or day before surgery is included in the global package (unless it's the *decision for surgery*) 

THEREFORE ...
Given the limited info you'd stated, I'm gonna guess that the decision for surgery is made at the office visit (new patient). So I'd code the 99201-99205 with a -57 modifier (or -25 depending if procedure is minor or major surgery), and I wouldn't code the H&P at all. Course, I'd be willing to listen to arguments for coding the Initial Hospital visit with the -57 modifier ... it's just that this sounds to me like the *decision for surgery *was made at the office visit. 

Just my humble opinion.

F Tessa Bartels, CPC, CPC-E/M


----------



## Lisa Bledsoe (Nov 18, 2008)

What about coding initial hospital if the decision for surgery *and admit *were determined at the time of the office visit?


----------



## crhunt78 (Nov 18, 2008)

Lisa Curtis said:


> What about coding initial hospital if the decision for surgery *and admit *were determined at the time of the office visit?



I ran across this one a couple of weeks ago.  I think you should bill for the hospital admit, not the office E/M.  Make sure you use the 57 modifier though!  But, you cannot charge the office visit AND the initial admit together.


----------



## Lisa Bledsoe (Nov 19, 2008)

Absolutely!


----------

