Wiki H&P same day as decision for surgery

[AShetler]

I have an office where the surgeon or PAs are seeing new and established patients and making the decision for surgery. We can bill the decision for surgery and it's not considered part of the global surgery package. However, they are then also scheduling the surgery and doing the H&P during this same visit. They are then documenting that this is the H&P. Since they are now doing the H&P on the same day as the decision for surgery is this visit still billable or does this now get rolled into the global surgery package because they are now indicating it is the H&P? These are normally done several weeks before the surgery is scheduled.

 

[LLovett]

If the decision for surgery was already made at another visit, and this visit is just to clear the patient for surgery and get the H&P on file. Since it is being performed within 24hrs prior to the procedure it is included in the global package and not separately billable. Which is appropriate.

If this is the visit in which the decision for surgery is made and it happens to be within 24hrs and the H&P is being done at the same time, it would be separately billable with the 57 modifier.

The key to your issue is going to be when the decision for surgery is made.


http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf

Medicare includes the following services in the global surgery payment when they provide them in addition to the surgery:
? Pre-operative visits after the decision is made to operate. For major procedures, this includes preoperative visits the day before the day of surgery. For minor procedures, this includes pre-operative visits the day of surgery;


I hope this helps,

Laura, CPC, CPMA, CPC-I, CANPC, CEMC