Wiki Bronchoscopy and Subsequent Hospital Visit

[bettze1947]

I have found the following scenario when auditing for our pulmonologists: patient admitted to hospital, pulmonary consult is requested and done. The consult report states patient will need a bronch.
Q 1. Does there need to be a request in the medical record from the attending
physician for the Bronch to be performed after the consult
Q 2. The bronch is usually done the next day, but the Pulmonologist is billing for a
Subsequent Hospital Visit on the same day as he does the Bronch. The
Subsequent Visit isn't made for a diffferrent DX or to make the decision for the
procedure. Can the same Dr. (pulmonologist) bill for a Subsequent Visit and
perform the Bronch on the same day and be paid for both when the DX code
is the same? Wouldn't the visit be considered global to the Bronch?

I need to be able to cite an authoritative source and I can't find one.

 

[LLovett]

Treatment can be initiated during a consult so you would not need an additional request from the requesting provider.

The question is was it truly a consult or a transfer of care. Did the requesting provider want an opinion or advice on how to treat, or did they just want the pulmonologist to deal with the issue?

The subsequent day would not be appropriate on the same day of the procedure unless that is when the decision for surgery was made, then you would add the 57 modifier. The global period starts 24 hours before the procedure is done.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

http://www.cms.hhs.gov/transmittals/downloads/R782CP.pdf

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4215.pdf


Laura, CPC, CEMC

 

[bettze1947]

Response to your response

It was not a transfer of care, a consult was done, a report done and then the Bronch was done on the next day. The pulmonologist visited the pt as a follow-up to the consult on the same day the bronch was done. Nothing in his visit notes indicates there was a decision to perform the procedure, so a -57 modifier would not be indicated. Later the same day, he performed the bronch. The dx for both encounters was the same.
My thought is that if he did the bronch, the Subsequent Visit couldn't be billed as the reason for both was the same diagnosis and the procedure would be the only charge as the visit would be global.