Practice Management Alert

Question: I understand that I cannot bill for an H&P if there is a global because it is included in the surgery. Can we bill for an H&P if there is no global period?

California Subscriber

Answer: You cannot separately bill for the history and physical (H&P) your physician performs even for a procedure with a zero-day global period. Even when there is no global period associated with a code, there is an inherent E/M built into the fee for the code and as such this H&P is not a billable service.

Bottom line: Every code's global package includes the preoperative work performed by the physician before the procedure or service. Therefore, unless the E/M service is significant and separately identifiable, you cannot bill it.

Unless the office visit is medically necessary to reevaluate a condition, such as diabetes or hypertension, that may affect the proposed procedure, you should not bill for the visit that's strictly for obtaining pre-procedure information. Your pre-op H&P becomes an "administrative" H&P, especially if your physician made the decision to perform the procedure at another encounter.

Exception: Some payers, however, will cover preoperative consultation (99241-99245, Office consultation for a new or established patient, which requires these three key components...) for patients for whom the payer considers it medically necessary (such as patients who have a comorbidity that may complicate a surgery). Check with your payer to see if it has a local coverage determination on this matter. If you feel the visit is medically necessary, your primary or first diagnosis for the preoperative visit should be in the V72.8 (Other specified examinations) series, such as V72.84 (Preoperative examination, unspecified).

-- The answers to the Reader Questions and You Be the Billing Expert were reviewed by Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC.