Wiki E/M service not on the same date as a minor procedure

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frankal

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Can an office visit E/M code be billed that has taken place a couple days before a port placement is performed even though the port placement has already been scheduled? The reason why I ask is because our general surgery office gets referrals faxed over from an oncology office for our providers to place port-a-caths. When we receive the referral and records, the procedure is then scheduled with one of our providers. One of our physicians wants his patients to come in to the office so he can discuss this procedure in person with them to address any pt concerns, what the procedure entails and the complications that can happen from this procedure but this procedure is already being scheduled before the patient comes into the office to discuss. I am aware that the E/M service cannot be billed on the same day of the procedure unless there is a significant separate identifiable reason. But these services are not on the same day.
 
An E/M code may certainly be billed, but what you have to keep in mind, and what you should advise your provider, is that like any service it must be justified by medical necessity. An E/M requires as chief complaint as a reason for the visit, which should be a problem or condition that requires management by the physician. Your provider should document why this patient this needs to be brought in for a separate visit, e.g. is there a particular condition or comorbidity that creates a particular risk factor for the procedure that needs the physician's evaluation above and beyond the usual perioperative work? I think simply bringing the patient in to answer questions or address concerns would be difficult to support from a medical necessity standpoint as the patient could be screened for this in a phone call by office staff and questions and risks could be discussed, and then the patient could be scheduled if something is identified during that phone call which needs the physician's attention.
 
A procedure with a 10 day global period (such as 36561) does not have a pre-operative period. The total global period is 11 days - the day of the surgery and 10 days following. A pre-operative office visit could be billed.

Reference on page 5 here : https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf

That being said, I agree with Thomas that as with any E/M service, there should be medical necessity to bill.
 
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