Reader Questions:
Initial Visit vs. Consult
Published on Wed Dec 01, 1999
Question: A Medicare patient came to the ER with a broken hip. The primary-care physician (PCP) wrote the initial progress note and referred the patient to the orthopedic surgeon (OS) for treatment. The orthopedic surgeon saw the patient and did surgery on the same day. Can we code that initial visit as an initial consult? Should we use modifier -57 (decision for surgery)?
Virginia McGeorge
West Side Orthopedic Group, OH
Answer: Medicare asks who made the decision for surgery. If the answer is the OS, then the OSs first visit to the patient constitutes an evaluation and management (E/M) service that resulted in the initial decision to perform surgery. And the E/M can be billed separately and identified with the -57 modifier, even though it occurred on the same day as the surgery. The 24-hour preoperative period is included in the global fee for surgery, except as noted here. (The postoperative global period is 90 days.)
