Wiki pre op charge

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TanBro

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Wondering, if a patient comes in for an Ultrasound followed by an endometrial ablation, then schedules a surgery before leaving, can I charge an E/M for preop counseling? What I am reading is that it is billable, but provider must document that over 50% of the visit was her counseling and coordinating care for the surgery and document time. Is this correct? Or would it be included in global. Of course, modifier 57 if I can charge a E/M. Any advice would be appreciated.
 
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There's not enough information to provide a definitive answer. It seems the patient had a procedure today (ablation) and then scheduled another surgery prior to leaving. IF the patient had an E&M service that was not related to today's procedure or otherwise not included in global for the ablation, then it MAY be billable with -25. I'm not sure where you are reading that it's billable only if the provider documents >50% of visit was counseling/coordination of care and bill by time only. That definitely seems incorrect, especially by 2021 E&M guidelines.
Modifier -57 would apply to an E&M decision for surgery the same day or prior day for a major surgery with a 90 day global period. The procedure today (endometrial ablation) would have 0 global or 10 global depending on how it's performed. Unless the scheduled surgery is taking place the next day and has 90 day global, -57 would not apply.
Modifier -25 MAY be appropriate for today's E&M service if the documentation shows a significant and separately identifiable E&M service aside from today's procedures.
 

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I just want to emphasize that if anyone has a CPT manual with the 50% counseling/coordination of care requirement for time, your book is out of date and your boss needs to buy you the 2023 version, ASAP. :)
 
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csperoni said:
There's not enough information to provide a definitive answer. It seems the patient had a procedure today (ablation) and then scheduled another surgery prior to leaving. IF the patient had an E&M service that was not related to today's procedure or otherwise not included in global for the ablation, then it MAY be billable with -25. I'm not sure where you are reading that it's billable only if the provider documents >50% of visit was counseling/coordination of care and bill by time only. That definitely seems incorrect, especially by 2021 E&M guidelines.
Modifier -57 would apply to an E&M decision for surgery the same day or prior day for a major surgery with a 90 day global period. The procedure today (endometrial ablation) would have 0 global or 10 global depending on how it's performed. Unless the scheduled surgery is taking place the next day and has 90 day global, -57 would not apply.
Modifier -25 MAY be appropriate for today's E&M service if the documentation shows a significant and separately identifiable E&M service aside from today's procedures.
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I actually got that information on AAPC, it was an outdated article though so I'm sure it's changed so that is why I'm reaching out to ask opinions. My doctors where just wondering if they see someone for bleeding, did an ultrasound and biopsy in office, counseled the patient after and set up surgery for say a 58558 D&C could we bill for the time they took after the ultrasound and biopsy to counsel and preop the surgery they are about to schedule before leaving the office.
 
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jkyles said:
I just want to emphasize that if anyone has a CPT manual with the 50% counseling/coordination of care requirement for time, your book is out of date and your boss needs to buy you the 2023 version, ASAP. :)
Click to expand...
I actually got that information on AAPC, it was an outdated article though so I'm sure it's changed so that is why I'm reaching out to ask opinions. My doctors where just wondering if they see someone for bleeding, did an ultrasound and biopsy in office, counseled the patient after and set up surgery for say a 58558 D&C could we bill for the time they took after the ultrasound and biopsy to counsel and preop the surgery they are about to schedule before leaving the office.
 
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As long as the E&M is documented appropriately, indicating work not part of today's procedure, you may level the E&M by MDM or time (not counting any time performing the separately billed procedure), whichever works to your benefit. Modifier -25 on the E&M to indicate that work was above and beyond what was needed to perform today's procedure with 0 or 10 day global.
 
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csperoni said:
As long as the E&M is documented appropriately, indicating work not part of today's procedure, you may level the E&M by MDM or time (not counting any time performing the separately billed procedure), whichever works to your benefit. Modifier -25 on the E&M to indicate that work was above and beyond what was needed to perform today's procedure with 0 or 10 day global.
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Thankyou The article you posted helped a lot!! Great info! Thankyou again
 
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jkyles said:
I just want to emphasize that if anyone has a CPT manual with the 50% counseling/coordination of care requirement for time, your book is out of date and your boss needs to buy you the 2023 version, ASAP. :)
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Curious do you know what paige the surgery guidelines are on in the OPTUM 2023 book? Ive skimmed through it and didnt seeing surgery guidelines.
 
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tanyabrown said:
Curious do you know what paige the surgery guidelines are on in the OPTUM 2023 book? Ive skimmed through it and didnt seeing surgery guidelines.
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Hi there, I don't use the Optum book. I use the CPT manual because that's the official source for CPT codes.
 
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