A surgeon has an office visit to discuss a diagnosis and options of surgery. An E/M is charged for that date. A decision is made to do surgery but the patient wants to go talk with family does not return to the office for about 2-3 weeks. The surgeon does another complete history and exam and schedules the surgery. (Can this visit be charged or is it considered now to be part of History and physical as the global for the surgery. My thought was the decision was made on the first visit but the surgeon says she has to do another assessment due to the time factor of greater than 30 days from the decision sometimes. I do have CPT assistant and CMS guidelines. I am looking for a document that talks about the decision made greater than 30 days based on the patient needing time to decide what to do? thank you
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Wiki History and Physical for surgery
- Thread starter SSweetland
- Start date
1formissy
Guru
Well, the E/M would not be considered part of the global becuase the surgery was not done. If the provider performs another H&P for the patient 30 days after the 1st one, that would be completely appropriate to report the H&P as long as the documentation supports the medical necessity.
I audit E/M claims for a insurance carrier, and I have seen several cases such as yours.
I audit E/M claims for a insurance carrier, and I have seen several cases such as yours.
Thank you for your response so are you saying she can charge for both visits
First visit is more of a counseling visit to discuss results and options. Possibly a time based if more than 50% is counseling. Then visit 2 is for the decision to proceed with the option of the patients. I would have thought this would have been the History and Physical visit to make sure there was no change in the patients health and would qualify for the required H&P since this is the surgeon.
First visit is more of a counseling visit to discuss results and options. Possibly a time based if more than 50% is counseling. Then visit 2 is for the decision to proceed with the option of the patients. I would have thought this would have been the History and Physical visit to make sure there was no change in the patients health and would qualify for the required H&P since this is the surgeon.
Missy
Can you clarify this, I think I interpret what you said wrong
First visit charge E/M
Second visit would be appropriate for the H&P - no charge if there was no change in patients condition because its part of the global package?
Can you clarify this, I think I interpret what you said wrong
First visit charge E/M
Second visit would be appropriate for the H&P - no charge if there was no change in patients condition because its part of the global package?