Wiki Global Period Hospital Visits and Decision for Surgery 90 Day Global

[coffee2day]

Hello,

How would one bill for a cardiology providers hospital visits with sudden decision for surgery 90 day global?

Example-

Visit - DOS 04/19 patient hospital visit admit for congestive heart failure issues and has a pacemaker, 99221
Visit - DOS 04/20 hospital visit no mention of a decision for surgery, ex 99232
Visit -DOS 04/21 hospital visit & pacemaker interrogation decision for surgery explanation patient agrees, this is the first instance of mention for decision for surgery ex 99232-57
Major surgery 90 day global - DOS 04/21 surgery done this date removal & replacement of pacemaker

The DOS 04/20 is hitting an coding edit for day prior to major surgery requiring a modifier 57, but decision for surgery wasn't made until dos 04/21. Any advice on how to bill these e&m codes for this scenario? Thanks so much in advance.

 

[yadavarvindkum]

The E/M service on DOS 04/20 would be billed without modifier 57. Since the decision of surgery was made on 04/21 and it is a procedure with 90 days global, modifier 57 would be appended on E/M service performed on 04/21.

Modifier 57 is to be used in the cases where decision to perform the surgery was taken a day prior OR it was decided on the day of major surgery (90 day post op).

Hope, this helps.

Thank you,
Arvind

 

[coffee2day]

Thank you, appreciate your feedback!