Wiki H&P on the same day as a preschdules procedure

[bkiesecker]

PLEASE help

patient comes in and is seen by a cardiologist the decision is made to do a cath
the next week the patient has their procedure and a H&P is done
the patient then goes home the next day.

what is billable

noridian is the medicare Fiscal Intermediary

there was no change in the patient statues and the there is no admitted to Inpatient or observation. there is also no complication and this is standard for all pre schedule caths

please advise and provide resource if available to support your point

thx in advance

 

[Love Coding!]

Anyone?

I am curious too? Does anyone know this?

 

[armen]

First E/M should be billed with modifier -57 "decision for surgery". I usually bill and H&P with, for example V72.83 but it will be denied and nobody should expect to get payment for H&P. There is no medical necessity for second visit.

 

[lynjones68]

First E/M should be billed with modifier -57 "decision for surgery". I usually bill and H&P with, for example V72.83 but it will be denied and nobody should expect to get payment for H&P. There is no medical necessity for second visit.

I agree. The second visit as the decision for the cath is already made, will be bundled into the procedure.

The only way the H&P/Consult will be billable is if the patient came in with another complaint (chest pain) and the decision was made for the cath at that time.

 

[colorectal surgeon]

Correct. The E/M with the decision for cath is billable but the second H&P visit is not billable. Why is the H&P not done at the time of the first visit? And the 57 modifier is only needed the day before or day of a major procedure.