OBSV with Prodedure at facility

valariej

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I have a physician who schedules a pt for an outpt procedure at the hospital. There are no global days for the procedure. (stent placement)

Pt is an outpt surgical pt status according to the hospital. Pt is not admitted as OBSV nor is there a written order by the physician to admit the pt to OBSV.

Physician wants to bill an OBSV code with modifier -25 in addition to the procedure because the hospital requires him to do an H & P prior to the procedure and because he is Observing the patient after the procedure.

I, say, "no", this is not a separate identifiable e/m and thus is included in the payment for the procedure. He states another coder says this is a "grey" area and it can be billed in addition to the procedure because the procedure does not have any global days.

All the research I have done states doesnt matter if there is zero, 10 or 90 global days, it cant be billed.

Please give me your feedback. What would you do???

THANKS MUCH!!!!!:
 

Herbie Lorona

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I dont believe an observation code would apply but if they are requesting his opinion or advise maybe a 99241 - 99245. I would think that if he scheduled the patient to have this procedure that they wouldn't need him to see the patient because he already cleared this pt to have this procedure
 

Lisa Bledsoe

True Blue
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Just because he is required by the facility to do an H&P does not warrant coding an E/M that would be inclusive to the procedure. All procedures have an E/M component to them. I do not see this as a "grey area" and would advise him not to code this way. Bottom line - no admit order = no admit code (observation or otherwise).
 

Herbie Lorona

Expert
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Yuma
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Yeah I agree especially if he is the one that scheduled the patient to go in for the procedure. He obviously cleared that patient to go have the stent put in.
 
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