Inpatient planned procedure

maryv22

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Question:
A patient is consulted with ENT on 6/20/16 due to hx of SMA type 1 and evaluation for tracheostomy. They state that they will plan for tracheostomy on 6/22/16. I can bill for the consult on 6/20/16, but could I also bill for the subsequent visit on 6/22/16 with a 25 modifier?

Please advise.

Thanks!
Mary
 

thomas7331

True Blue
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It really depends on what is documented on 6/22/16. Since the workup and decision for the procedure was already made, a separate E&M on the day of the procedure would only be appropriate if there was significant and separately identifiable E&M, e.g. if there had been a change in the patient's condition requiring new E&M or if the provider was managing other problems unrelated to the procedure at the same time.
 
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