General Surgery Coding Alert

Reader Question:

Decision for Surgery Payable Separately

Published on Sun Jul 01, 2001

Question: One of my physicians attended a seminar in which he was told if he sees a patient in the emergency department (ED), and then performs a procedure (for example, an appendectomy), the E/M is part of the procedures global package and shouldnt be billed. I disagree: He had to do an examination, a history and medical decision-making to decide to perform the procedure. I believe he should bill an E/M with modifier -57, as well as the procedure. Who is correct?

Pennsylvania Subscriber

Answer: You are, says Arlene Morrow, CPC, CMM, a general surgery coding and reimbursement specialist in Tampa, Fla. The global surgery guidelines in the Medicare Carriers Manual, section 4821B, clearly state, the initial consultation or evaluation of the problem by the surgeon to determine the need for surgery is not included in a procedures global surgical package.

Therefore, if the surgeon performed an appendectomy (44950) after evaluating the patient in the ED and determining that surgery was required, the appropriate-level E/M code should be billed with modifier -57 (decision for surgery) appended.

Note: If a decision is made to perform a procedure with a 0- or 10-day global period, modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) should be used in place of modifier -57.

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