Surgeon in ED

kjferg47

Networker
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Nassau County
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Can someone offer me some advice?

1) I have been asked to "audit" a surgeon who on many occasions will see patients in the ED at the request of another physician. About 30-40% of the time he ends up doing surgery on these patients on the same day - can he bill a consultation for those visits or has he assumed the care of the patients by performing surgery on them?

Any help is greatly appreciated.
 

RebeccaWoodward*

True Blue
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North Carolina
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Consultation Followed by Treatment
A physician or qualified NPP consultant may initiate diagnostic services and treatment at the initial consultation service or subsequent visit. Ongoing management, following the initial consultation service by the consultant physician, shall not be reported with consultation service codes. These services shall be reported as subsequent visits for the appropriate place of service and level of service. Payment for a consultation service shall be made regardless of treatment initiation unless a transfer of care occurs.



B. Services Not Included in the Global Surgical Package

The initial consultation or evaluation of the problem by the surgeon to determine the need for surgery. Please note that this policy only applies to major surgical procedures. The initial evaluation is always included in the allowance for a minor surgical procedure;

If evaluation and management services occur on the day of surgery, the physician bills using modifier “-57,� not “-25.� The “-57� modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. Moreover, where the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf
 

kjferg47

Networker
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Nassau County
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Thanks Rebecca. This is perfect. As I read your response it sounded familiar - I should have known that already!

Thanks again for the speedy and extremely helpful response.
 
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