Wiki History and Physical Billing

[Trendale]

Hello,
One of the physician's I code for is trying to bill a H&P the day of the surgery. He has already billed a new patient visit tht same day. I did not think we can bill the H&P, I thought it was included in the 90 day surgical package ( The day before and the day of).When is it appropriate to bill for the H&P? Thanks!

 

[FTessaBartels]

Two problems

First ...
You cannot bill both the office visit AND the H&P on the same date of service. CPT tells you to roll all the work done together to determine your level of service for the H&P.

Second ...
An E/M on the day of or day before surgery is included in the global package (unless it's the decision for surgery)

THEREFORE ...
Given the limited info you'd stated, I'm gonna guess that the decision for surgery is made at the office visit (new patient). So I'd code the 99201-99205 with a -57 modifier (or -25 depending if procedure is minor or major surgery), and I wouldn't code the H&P at all. Course, I'd be willing to listen to arguments for coding the Initial Hospital visit with the -57 modifier ... it's just that this sounds to me like the decision for surgery was made at the office visit.

Just my humble opinion.

F Tessa Bartels, CPC, CPC-E/M

 

[Lisa Bledsoe]

What about coding initial hospital if the decision for surgery and admit were determined at the time of the office visit?

 

[crhunt78]

What about coding initial hospital if the decision for surgery and admit were determined at the time of the office visit?

I ran across this one a couple of weeks ago. I think you should bill for the hospital admit, not the office E/M. Make sure you use the 57 modifier though! But, you cannot charge the office visit AND the initial admit together.

 

[Lisa Bledsoe]

Absolutely!