General Surgery Coding Alert

Rest homes require a different POS code than nursing facilities The financial health of many physician practices depends on coding E/M services correctly -- but many coders are puzzled by E/M coding rules. Use the following FAQ to clear up the most confusing E/M scenarios. 1. Report Pre-Op Exams With Caution Question: When we schedule elective surgery on one of our patients, we also schedule a history and physical (H/P) to be done in our office by one of our physician's assistants. We had always believed that the H/P was part of the global service, and we have never charged for these. But we were recently advised that if this H/P is done more than 48 hours prior to the procedure, which it often is, that we can charge. Should we charge for such an H/P? Answer: This question represents one of the many gray areas of coding, and the answer will depend on the specifics of your surgeon's visit.

-An H/P done the day before or the day of surgery is included in the global,- says Suzan Hvizdash, BS, CPC, CPC-EMS, CPC-EDS, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh. But you-ll have to carefully examine the specifics of any visit two days or more before the surgery.

Suppose the physician saw the patient two months ago and at that visit decided to perform the surgery. Now the patient (who is in good general health) returns to your office for an H/P because the hospital requires it before the surgery. -If the H/P is only a hospital requirement and not medically necessary, then no matter when the surgeon performs it, it isn't billable,- Hvizdash says.

-If, however, the patient gets all the proper clearances, but the surgeon saw the patient when she was dealing with an active issue, the H/P might be necessary,- Hvizdash says. -The surgeon needs to make certain that the patient is healthy enough to withstand surgery. If this is the case, the H/P done more than a day before surgery is billable.-

Special note: The Office of Inspector General's 2007 Work Plan has targeted E/M services during the global period for special scrutiny, so you-ll only want to charge separately for a pre-op H/P if documentation supports medical necessity. -A good rule of thumb would be if the H/P is required by the surgeon (because of underlying medical conditions), it's probably billable. If required by the hospital, it's probably not billable,- Hvizdash says.

You can view the OIG's 2007 Work Plan at http://oig.hhs.gov/publications/docs/workplan/2007/Work%20Plan%202007.pdf. 2. Codes Differ for Rest Home, Nursing Facility Question: Should I use the same codes when the surgeon performs an E/M service on a rest home patient as I would if [...]