Orthopedic Coding Alert

Question: For elective surgery, our physician assistant (PA) usually performs the history and physical (H&P) portion of the exam. If we do this more than two days prior to the surgery, can we charge for an office visit (99213)? Do we need a modifier of any kind? We aren't charging for the H&P, and our bookkeeper thinks we can do so.

Florida Subscriber

Answer: The real question at issue is not whether you can charge for the service, but whether your practice should regardless of who performs the service (the PA, the orthopedist, or any other clinician). Officially speaking, the global period of a major surgery includes the day of the surgery and the day before. Therefore, you can technically bill for an H&P performed two days before the surgery, either under the PA's number or, if following "incident-to" guidelines, under the physician's personal identification number (PIN).

Carriers may question this type of coding practice on an ethical basis, however, because if your practice scheduled the surgery ahead of time, but specifically performed the H&P two days beforehand to circumvent the global period, many payers would consider that an attempt to game the system. They would probably pay for the visit separately only if it was medically necessary for reasons other than the surgery.

If you are using V72.83 (Other specified pre-operative examination), most payers will deny the visit as included in the surgery. If the patient's visit is for preoperative clearance only, include it in the charge for the surgery.

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