Wiki Three E&M coding scenarios I need help with.

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ssebikari

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Scenario 1:
Prior to laparoscopic appendectomy, surgeon examines the patient according to the E&M notes, patient to be discharged on same day. Physician has billed 99219 and 44970. If patient was admitted and discharged on the same day, wouldn't a 99234-99236 be the appropriate code?? I need some confirmation on this.

Scenario 2:
Physician is called by the ER for a consult after attempted failed treatment of metacarpophalangeal dislocation by ER doc. Physician bills 99243-25 and 26715. Is this appropriate?

Scenario 3:
Patient has an enterectomy(44120) for enteritis, intestinal obstruction & complication of colostomy and is in-patient for 4 days after the procedure. Can the surgeon bill 99231 for each day that they see the patient for a related dx of diverticulosis?? Would the subsequent hosp visit be considered part of the global period of 90 days post op?
Any help is much appreciated!
 
Please see responses in blue.

Scenario 1: The physician would only bill for the surgery. Pre and postoperative care including admission/discharge unless the E/M resulted in the decision for surgery, which you would append modifier 57 to the E/M and bill the surgery. Prior to laparoscopic appendectomy, surgeon examines the patient according to the E&M notes, patient to be discharged on same day. Physician has billed 99219 and 44970. If patient was admitted and discharged on the same day, wouldn't a 99234-99236 be the appropriate code?? I need some confirmation on this.

Scenario 2:Yes this is fine, given the documentation supports both services. However, some payers might want the 57 modifier instead of 25, check with your payer.
Physician is called by the ER for a consult after attempted failed treatment of metacarpophalangeal dislocation by ER doc. Physician bills 99243-25 and 26715. Is this appropriate?

Scenario 3:I would consider the 4 days to be postoperative and included in the global period.
Patient has an enterectomy(44120) for enteritis, intestinal obstruction & complication of colostomy and is in-patient for 4 days after the procedure. Can the surgeon bill 99231 for each day that they see the patient for a related dx of diverticulosis?? Would the subsequent hosp visit be considered part of the global period of 90 days post op?


Hope that helps...:)
 
Scenario 1

I agree with AR. But to expand ... the reason you would code the admission and not the admit/discharge on same day is that only the E/M that results in the decision for surgery is exempt from the global period. The "discharge" part of the service is covered by the global period for the surgery. The admission, assuming it was the decision for surgery (as it usually the case for appendectomy), would be coded with -57 modifier.

Check your hospital recrods carefull to see if patient was admitted as an inpatient or for "day surgery" (observation code).

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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