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Wiki H&P/Same day admission

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Trendale

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Hi,
Can someone help me with billing for preoperative H&P billing? It is to my understanding, according to the global surgical package, if the preop H&P is performed the day before the surgery, it is bundled with the surgery, as it is part of the global surgery package. So if the preop H&P is performed two days or a few days before the surgery, is this billable? I've noticed the physician that I code for has been submitting his preop H&P for billing. In some cases it is before the surgery and in some cases it is a few days prior to the surgery. I would bill the initial inpatient consult codes for this. Also, I was told to use the admission date for the H&P, as the H&P is always the same as the admission date. (There is no other specified date)

I just want to make sure I have the facts straight before I present this issue to him. Is there any supporting documentation that I can show? Thanks!
 
New patient or established?

If it is the FIRST time the surgeon is seeing the patient, it is appropriate for the surgeon to bill out either a new patient visit or a consult (depending on the circumstances and documentation). If that first visit is the day of or day immediately prior to surgery you would use the -57 modifier (for major surgery) or -25 modifier (if same-day minor procedure) on the E/M code.

If the decision for surgery was made previously, and you are having the patient come into the office just to get the hospital required H&P done, then there is no medical necessity for the visit, and it is not billable (even if it's done 3 days prior to surgery).

The date of service on all your documentation should be the date the physician actually saw the patient and provided service. If you're doing your H&P's in advance you should be able to have TWO dates on the document: Date of service and Date of hospital admission.

Hope this helps.

F Tessa Bartels, CPC, CPC-E/M
 
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