Orthopedic Coding Alert

Question: One of the surgeons in my practice insists that history and physical (H&P), discharge and transfer summaries can be billed separately from global. I am under the impression that these items are all included in the surgery code. Who is correct?

Arizona Subscriber

Answer: If this is a planned admission for elective surgery, the H&P, discharge and transfer summaries are all included in the global package for the surgery and not billable separately. However, if the doctor is called to the hospital to assess an injured or acutely ill patient, determines that surgery is required and immediately admits the patient, he can report a code for initial hospital care (99221-99223) with modifier -57 (decision for surgery). The discharge summary is not billable.
 
Similarly, if he is called in for a consultation and decides to operate, the consultation code (99251-99255, initial inpatient consultation ...) can be reported with modifier -57 appended.

    
Answers to You Be the Coder and Reader Questions were provided by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J.