hospital consult

lisatf

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my office is having trouble with hospital consults. I am coding a hospital e/m and a procedure on the same day using modifier 26. we are not getting paid for the consult. am i coding this wrong? if yes how should this be coded?
 

csperoni

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Modifier 26 is for professional component, typically on a diagnostic test. -26 would not apply to E/M services.
1) As always, I question your use of the word "consult" that it meets the coding definition of consult.
2) Depending on the procedure done, and potential global period, AND whether or not the E/M service lead to the decision to perform the procedure, there are several potential modifiers.
3) I would refer you to the Medicare Global Surgery booklet https://www.cms.gov/Outreach-and-Ed...oducts/Downloads/GloballSurgery-ICN907166.pdf to determine if the E/M provided is billable, and if it is, the best modifier choice.
 
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