Quick Tip: Pre-surgical H&P Is Included in Global Package
- By John Verhovshek
- In Billing
- November 23, 2015
- Comments Off on Quick Tip: Pre-surgical H&P Is Included in Global Package
Per CPT® guidelines, a history and physical performed subsequent to the decision for the surgical procedure is included in the global surgical package. Do not report a separate evaluation and management (E/M) service for the history and physical unless the decision for the surgery is made at the same encounter, on the day of or day before the surgery.
For example, a patient presents to the emergency department with an acute appendicitis and is taken to surgery. The surgeon performing the surgery may report an E/M service code for the evaluation and history and physical. Modifier 57 Decision for surgery is appended to the E/M service code to indicate the E/M is not included in the surgical package.
John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.
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We had a scenario that arose regarding office visits that would occur subsequent to the decision for surgery while also a week or more prior to the surgery. After much correspondence, our regional Medicare carrier clarified that these visits are separately reportable from the global, even if they are for the purpose of re-evaluating the patient’s problem status and ensuring the patient is still physically able to undergo the procedure. The MAC’s primary rationale for allowing these visits was that they are taking place more than one day prior to the surgery and therefore are outside of the time constraints of the defined global period. Even with the MAC’s written response in hand, I still feel a twinge of hesitancy, since these visits would definitely not be separately covered if they were occurring on the day before or day of surgery. This seems to open the door for potential unbundling if it all hinges primarily on the timing of the visit, rather than the nature of the visit. Could you please give me your feedback on that? Thank you!
We also recently encountered this issue.
We found the following in The Coding Institute, E/M Coding Alert, January 2016, Vol. 4, No. 1, beginning on page 1in the article titled Follow 3 Tips to Successfully Report Pre-op Clearance Encounters. The last paragraph of this article is titled Differentiate Pre-op Clearance and H&P. In this paragraph it explains that if the physician who is performing the surgery is seeing the patient just to perform a general physical to confirm that the upcoming surgery is still the best course of action, but the decision for the surgery was already previously made, than that encounter is included in the global surgery package for the procedure and you cannot report the E/M encounter seperately.