Orthopedic Coding Alert

Is presurgical H&P part of global? The answer may surprise you The financial health of many orthopedic practices depends on coding evaluation and management services correctly, but many coders are continually puzzled by E/M coding rules. For a quick and dirty E/M refresher, review the following three FAQs to get up to speed. Decide When to Include Pre-Op in Global

Question 1: When we schedule elective surgery on one of our patients, we also schedule a history and physical (H&P) to be done in our office by one of our physician's assistants. We-ve always believed that the H&P was part of the global service, and we have never charged for it. But we were recently advised that if this H&P is done more than 48 hours prior to the procedure, which it often is, we can charge. We would like to know whether we can and whether we should charge for such an H&P. Answer: This question represents one of the many -gray- areas of coding, so the answer will depend on the specifics of your surgeon's visit. -It is true that an H&P done the day before or the day of surgery is included in the global,- says Suzan Hvizdash, BS, CPC, CPC-EMS, CPC-EDS, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh. However, you-ll have to carefully examine the specifics of any visit two days or more before the surgery.

Suppose the physician saw the patient two months ago, and at that visit he made the decision to perform the surgery. Now the patient (who is in good general health) returns to your office for an H&P because the hospital requires it before the surgery. -If the H&P is only a hospital requirement and not medically necessary, then no matter when the surgeon performs it, it isn't billable,- Hvizdash says. Medical Necessity Makes the Difference -If, however, the patient gets all the proper clearances, but the surgeon saw the patient when she was dealing with an active issue, the H&P might be necessary,- Hvizdash says. -The surgeon needs to make certain that the patient is healthy enough to withstand surgery. If this is the case, the H&P done more than a day before surgery is billable.-

For example: Your patient requires a hip replacement but has rheumatoid arthritis and diabetes, so the physician wants to examine her again before the hip replacement to ensure that her conditions are being managed properly before he performs the arthroplasty.

Remember: -It should all be clear in the documentation,- Hvizdash says. -But, a rule of thumb would be if the H&P is required by the surgeon (because of underlying medical conditions), it's probably billable. If required by the hospital, it's probably not [...]