Eli's Rehab Report

Question: Our physician assistant (PA) usually performs the history and physical (H&P) portion of preoperative exams. If we do this more than two days prior to the surgery, can we charge an office visit (99213) for this service? 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 a PA can do it, but whether your practice should charge for it regardless of who performs the service (the PA, the physiatrist or any other clinician). Officially, the global period of a major surgery includes the day of the surgery and the day before. Therefore, an H&P performed two days before the surgery is technically billable, either under the PA's personal identification number (PIN) or, if you are following "incident-to" guidelines, under the physiatrist's PIN.

Carriers may question this type of coding practice on an ethical basis, however, because if the 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 separately only for the visit 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 being inclusive in the surgery.

If the patient's visit is for preoperative clearance only, include it in the charge for the surgery.