Wiki Decision for Surgery & Sub.HospVisits

[Hopp]

Just wondering if someone would be able to help? I am coding for a general surgeon and have only been doing this for a year - Learning as I go.
How would you code the following: Admission on example: 12/08/08 -
99223 for abd. pain 789.07
Sub.Hosp.visit on 12/09/08 99232 and then surgery on 12/10/08.(My doc also states sub.hosp.visit on this day also 12/10/08; but I dont think I can bill that)
Is that true?
If I put the decision for surgery on the visit for 12/09 then I get denied for the admission due to preop global. So do I just code for the admission with the 57 modifier and then not the visit on 12/09 and 12/10. (Say this was for a cholecystectomy) Thanks for any help!
cricket

 

[mkj2486]

When was the decision for surgery? If you have the documentation you can bill admission, all the subsequent hosp. visits and the 57 on the 12/10 visit. It all depends on what was documented in the physician's note, and when the decision for surgery was made. If the decision was made on the admission, but the patient was not able to have the surgery because of another medical reason and the patient had to be evaluated as to when they were well enough, you should still be able to bill the visits. As long as you have documentation of medical necessity. At least that is my opinion.

 

[crhunt78]

When was the decision for surgery? If you have the documentation you can bill admission, all the subsequent hosp. visits and the 57 on the 12/10 visit. It all depends on what was documented in the physician's note, and when the decision for surgery was made. If the decision was made on the admission, but the patient was not able to have the surgery because of another medical reason and the patient had to be evaluated as to when they were well enough, you should still be able to bill the visits. As long as you have documentation of medical necessity. At least that is my opinion.

I agree. As long as the physician documented that he didn't decide to do the surgery until the 12/10 visit, you can bill for all visits. I just had a case similar to this not too long ago. I did have to send in a letter of appeal with the notes but I did get paid for the admission and the subsequent visits before the surgery. Good luck!