Is office visit included with surgery in hospital ??


Tucson , AZ
Best answers
This question has probably been asked before, but one of our doc's saw a pt in the office, 99203 and scheduled him for surgery the next day in the hospital, (pt stayed in hospital for 3 days). The doctor states that he "will perform the surgery tomorrow". Can I add a 57 modifier to the 99203, or is it included? I ask because I'm getting conflicting answers. When I read the CPT book, in the Hospital Inpatient Services section, it states "When pt is admitted to hospital as an inpt in course of an encounter in another site of service (eg, ....physicians office...) all E/M services provided by physician in conjunction with that admsssion are considered part of the initial hosp care when performed on the same date as the admission". But in the Surgery Guidelines section for surgical package definition it state "Subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of procedure..." as an included service.
So now I'm a confused. Any information would be greatly appreciated.

Thanks :confused:
If the surgery that was done is considered a "major surgery" (if it has a 90 day global surgery followup period) then you can and should charge for the EM visit with a 57 modifier if the decision for the surgery was made/discussed at the time of the EM visit.
You are mixing two guidelines

Guideline re -57 modifier.
The physician saw the patient in the office and decided patient needed surgery. Surgery is scheduled for the next day.
You will need a -57 modifier on this code IF the surgery has a 90 day global period.

Guidelines re office visit which becomes an inpatient stay
If the physician saw the patient in the office and decided to admit the patient the same day - AND the physician also saw the patient in the hospital - you will code the Initial Hospital visit, combining ALL the documentation into one code.

Now, combining your scenario ... patient seen in the office and sent directly to hospital for admission for surgery the next day.

You would code the initial hospital visit (I'm assuming physician also saw patient in the hospital) with a -57 modifier to show it was the decision for surgery.

If your physician (or one of his/her partners in the same specialty) did NOT actually admit the patient ... for example, general surgeon sees patient in office and schedules hernia surgery for tomorrow; patient is admitted to hospital by hospitalist ...
then code only the office visit for your surgeon with the -57 modifier.

Hope that helps.

F Tessa Bartels, CPC, CEMC