Ob-Gyn Coding Alert

In a move to explain what is and isnt included in the global surgical package, CPT 2002 includes new, specific language as to the components of the package. The language is included at the front of the surgical guidelines section under the heading CPT Surgical Package Definition:
 
The services provided by the physician to any patient by their very nature are variable. The CPT codes that represent a readily identifiable surgical procedure thereby include, on a procedure-by-procedure basis, a variety of services. In defining the specific service included in a given CPT surgical code, the following services are always included in addition to the operation:
 
local infiltration, metacarpal/metatarsal/digital block or topical anesthesia
 
subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of the procedure (including history and physical)
 
immediate postoperative care, including dictating operative notes, talking with the family and other physicians
 
writing orders
 
evaluating the patient in the postanesthesia recovery area
 
typical postoperative follow-up care.
E/M Encounter Is Critical Change  
The most significant aspect of the new language relates to the preoperative E/M visit with history and physical. Prior to this, says Melanie Witt, RN, CPC, MA, an independent coding educator from Fredericksburg, Va., and an ob/gyn coding expert, CPT never specified that any E/M services were included in the surgical package. Now they include an E/M service on the day of or day before surgery if it relates to the surgery but is not the visit at which the decision for surgery was made.
 
For example, if a physician conducts a history and physical (H&P) on the patient the day of or the day before surgery, on an inpatient or outpatient basis, the H&P is included in the global charge. Some disagreement may occur when the physician performs the H&P after deciding to do surgery, but performs it more than two days prior to the surgery. The CPT guidelines indicate that the E/M visit (9921x) that occurs more than a day before surgery can be billed outside of the global surgical package. But it remains to be seen whether insurance companies will interpret the new guideline in this manner, or not pay for any preoperative H&P.
 
The physician should still be performing the E/M service that includes H&P in preparation for the surgery in a time frame that is in the best interest of the patient from a clinical perspective, says Philip N. Eskew Jr., MD, medical director of Women and Infant Services at St. Vincents Hospital in Indianapolis, and this may mean that the H&P is done a week before surgery. Eskew feels that rather than schedule the H&P two or three days before surgery, providers [...]