General Surgery Coding Alert
Pre-Op Visits Require Medical Necessity
Question: Our surgeon wants to send a patient back to her primary-care physician (PCP) for clearance for surgery. Can he do that, and if he can, does that mean the PCP has performed the preoperative portion of the global service? Virginia Subscriber Answer: Yes, the surgeon can send the patient to the PCP, as long as medical necessity supports the need for the clearance. For example, PCP clearance may be appropriate for a patient with congestive heart failure and poorly controlled diabetes who needs a cholecystectomy.
PCP clearance, however, would not replace the surgeons normal preoperative services. Your surgeon will still need to examine the patient on the day of surgery to determine if there are any contraindications or changes that should be noted prior to beginning surgery.This examination will fulfill the requirements of the preoperative exam.
General Surgery Coding Alert
- Part 1:
Visualize Better Payment for Sentinel Node Biopsy Procedures
Although the AMA and CPT state that you shouldnt use 38792 and 78195 during the [...] - Part 1:
Understand Global Periods and Avoid a World of Hurt
So-called "global" periods which define a package of services or care associated with and bundled [...] - You Be The Coder:
Get Preauthorization for Varicose Vein Injections
Question: Payers routinely reject our claims for varicose vein injections. What are we doing wrong? [...] - CCI 9.1:
New Companions for Caths,Pancreatic Procedures
Of the more than 4,700 changes to the national Correct Coding Initiative (CCI) this quarter [...] - Global-Period Lengths Vary
Under Medicare guidelines as established by the Physician Fee Schedule, there are four primary global [...] - Correction:
BundledJejunostomy and Mesh Removal
The February 2003 General Surgery Coding Alert ("Watch for Bundled Jejunostomy") should have stated that [...] - READER QUESTION:
Medicare Specifies -AS for PAs in Surgery
Question: In the past, Ive always reported modifier -80 for a certified PA in the [...] - READER QUESTION:
Significant Additional Work Warrants -22
Question: If the physician spends an additional 30 minutes lysing adhesions during a laparoscopic chole-cystectomy, [...] - READER QUESTION:
No Fixed Guidelines for -63
Question: What can you tell me about the new-for-2003 modifier -63? Georgia Subscriber Answer: Insurers [...] - Keep an Eye on Observation Coding to Avoid Blurry E/M Reporting
Many general surgery coders have no trouble following CPT rules for hospital observation services, but [...] - You Be the Coder:
Face-to-Face Time During Counseling Sessions
Question: Our surgeon spent time during an office visit counseling a new patient prior to [...] - 3 Guidelines for Better Discharge Reimbursement
General surgery coders may not use hospital discharge services codes often, but when they do, [...] - Emphasize Surgeons Expertise To Increase Concurrent Care Pay
When a surgeon works concurrently with other physicians to treat a patient, you'll stand a [...] - READER QUESTION:
Include Consult in ED Observation
Question: If the emergency department (ED) physician requests a consultation from a surgeon for a [...] - READER QUESTION:
Treat Two-Surgeon Visits Individually
Question: How should we report the following situation: Dr. Afrom our surgery group admits a [...] - READER QUESTION:
Same-Day Discharges Get Single Code
Question: One of our surgeons saw a patient in the hospital and coded the visit [...] - READER QUESTION:
Pre-Op Visits Require Medical Necessity
Question: Our surgeon wants to send a patient back to her primary-care physician (PCP) for [...] - READER QUESTION:
Report NP Work for Surgical Assist
Question: Two providers (one a surgeon and the other a nurse practitioner [NP]) worked together [...]
