In Coding
Oct 24th, 2016
If you think of modifier 57 as the “decision for surgery” modifier, it’s time to change your mind. Modifier 57 applies when the physician determines the need for any major procedure—whether surgical or non-surgical. “Major” Means 90-Day Global Period The CPT® manual doesn’t define “major” or “minor” procedures, but the Centers for Medicare & Medicaid ...
In Billing
Nov 23rd, 2015
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 ...
In Billing
Dec 8th, 2014
As a general rule, an E/M service provided on the day of, or the day prior to, a major surgical procedure is included and paid for within the global surgical package of that procedure—unless the E/M service, itself, leads to the decision to perform surgery. Stated another way: A routine history and physical (H&P) prior ...
In Coding
Jan 29th, 2013
History and physicals before surgery can be potholes in the road for reimbursement if reported incorrectly. Watch the circumstances under which the physical is performed to prevent a fiscal flat tire. In most cases, if the surgeon performs a history and physical (H&P) to clear a patient for a scheduled surgery, you should not report ...
Aug 1st, 2012
By Nancy Clark, CPC, CPC-I Modifiers are crucial in telling the story of the claim by identifying procedures that have been altered in some way without changing the core meaning of the code(s) submitted. Let’s look at the modifiers that can be appended to evaluation and management (E/M) codes used within the global period. The ...