H&p Billing Question

VICKIN

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Can the doctor that is doing the surgery bill an E/M code for an Office Visit if the patient comes in 2-3weeks before surgery to see him to have the surgical H&P done? Or is that H&P (even though it is 2-3 weeks before surgery) included in the surgical package? If an E/M code can be used to bill for this Office Visit do you need to have a seperate H&P and Office note dictated?
 

kevbshields

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Fom a payer/compliance perspective, I'd question the medical necessity of the service.

H&Ps done in this fashion satisfy the administrative requirements for hospital admission, they also validate patient history; but, are they medically necessary? Is there a true purpose to the visit aside from that mentioned above?

I suppose what I'm saying here is that if the patient had changes in condition, discovery of a latent problem during Pre-op clearance or other special circumstance that changed the clinical picture, I can see it necessary to present for a separate evaluation prior to the surgical encounter. What I have had a difficult time with in the past was getting providers to illustrate the need of such service. To me, this must be handled on a case by case basis, but I'd scrutinize "habits" of providers getting those patients in the office outside the global. Keep in mind OIG has said it would step up reviews of E/M services performed in the CPT global package period. I think the next step will be services that you describe.

Good luck to you.
 

tahoffman01

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I would say that this would be included in the surgical package. You need to do a "Pre-op" to ascertain that a patient is healthy enough through surgery so unless it is done pertaining to something above and beyond the surgery I would not code it separately.
 
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