Wiki Billing for H&P during office visit

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GloriaPitre

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Can someone please help me??? During a regularly scheduled office visit, the H&P is done by the PA (surgery is scheduled for three weeks later) WHAT SERVICE(S) ARE BILLABLE?
 
This sounds like a preop visit and it is not billable. If the decision to perform the surgery was prior to the visit when the H&P is performed the 2nd visit is not a billable service unless there is a separate problem going on that required evaulation and a parallel treatment plan.

Source: AMA CPT Assistant May 2009
.....the interval visit where the intent of the visit is the preop H&P, and this service occurs in teh interval between the decision-making visit and the day of surgery, regardless of when the visit occurs (1 day, 3 days, or 2 weeks), the visit is not separately billable as it is included in the surgical package.
 
Billing for H&P

Yes, that much I know. The patient had been considering surgery, at the next scheduled appointment with the doctor the patient agrees to surgery and a date is decided. Since the patient is already in the office the H&P is done, it was not pre-planned.

Can I bill the office visit (doctor service) and the H&P (PA service)?

Thanks for your response
 
I am assuming your physician is the surgeon here as you did not specify. The preop work of performing the H&P by the PA or a surgeon is inclusive of the preop work of the surgical procedure. As I am sure you are aware surgical procedures have 10% of each visit toward the preop. If you bill that work separately that is called "fracturing" charges and it is not allowed. Per the AMA, it cannot be billed as a separate visit.

H&P, reviewing diagnostics and no change in treatment plan is simply all inclusive to the surgical procedure and not billable as Medical Necessity isn't supported.

MDM is based on the physicians decision that surgery is needed to treat the patients problem, which appears to have occured at the previous visit here. Not when the patients decision to move forward with surgery. If there is no additional workup or decision making on the part of the provider during the 2nd visit when the patient informs the surgeon "let's schedule" this time/work falls withing the global bubble (not necessarily the global period).
 
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