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Thread: Billing Consult day before surgery

  1. #1

    Default Billing Consult day before surgery

    AAPC: Back to School
    Scenario: Cardiologist sees a patient and refers him to an EP physician. The EP physician sees the patient does your standard level 3 or 4 consult and then tells the patient that he will need to schedule him for the test. Patient has the EP test the next day.

    Physician is being told that he cannot bill the consult because it is within 3 days of the procedure. (some 3 day rule I have not heard of) EP does not have a 90 day global so why is the doctor being told this?

  2. #2


    Who is telling the physician this? Is this some weird insurance rule? And what is the patient scheduled for? a "diagnostic test" or "surgery"? The title of your post says surgery and in the post it says test, so I'm not sure. I've never heard of a "3 day rule" The EP doc should bill his consult accordingly, and IF the test is a physician service, he should bill for that too. IF it's "surgery" and the "consult" was the "decision for surgery" then you should put modifier 57 on the consultation.

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