General Surgery Coding Alert

Question: I work for a general surgeon in a solo practice. On occasion, he is called to the operating room during a surgical procedure by a surgeon of another specialty, such as urology. For example, he may be called into the operating room if a complication or unexpected finding occurs during a surgery. In some instances it is necessary to perform a procedure. Can we bill for an intraoperative consultation in conjunction with a surgical procedure in such cases, and if so, what procedure code would be appropriate? If he does only an intraoperative consult and doesnt perform any surgery at that time, how do we code for his services?

Anonymous West Virginia Subscriber

Answer: In this situation, a general surgeon can bill for an intraoperative consult by using codes 99251 through 99255 (initial inpatient consultations) or 99241 through 99245 (office or other outpatient consultations), based on the documentation, and the request from the other surgeon must be in the patients chart, says Barbara Cobuzzi, MBA, CPC, CCS-P, a coding and reimbursement specialist in Lakewood, N.J.

If the general surgeon performs a procedure after the consultation, either modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) or modifier -57 (decision for surgery) would have to be attached to the consult code, says Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding specialist in Lenzburg, Ill.