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Billing Inpatient Admissions with Surgery

  1. Default Billing Inpatient Admissions with Surgery
    Medical Coding Books
    Hi Everybody - just a very basic, almost stupid question; my doc admits patient to the hospital to do surgery on an inpatient basis, orthopaedic doc, for, let's say a total knee replacement. I am trying to verify in my own mind for 100% certain, I cannot bill the admission since we are doing the surgery, correct????

    Thanks - like I said, very simple and basic.

  2. #2
    Well, I don't think this is a stupid question. I have never really thought about it actually.

    If the decision for surgery is made that day and they are admitted, then you would bill the admission with a 57 modifier. If the decision for surgery was made prior, as with a scheduled procedure, no you would not bill the admit if it was the same day as the surgery.

    This got me to thinking though, a dangerous thing to do, lol.

    What if the admit is done greater than 24 hours prior to the surgery? You would be outside the global period, so it shouldn't hit bundling edits. I can envision a scenario where they need the patient to be on IV antibiotics for so many days before they do a procedure. To me that would be a justified reason to bill both the admit and a scheduled procedure.

    Hopefully someone else will post additional information on this. Most of the surgeries I deal with are emergencies, not scheduled. I haven't had an orthopod for almost a year now, but this has me wondering if we left money on the table and are continuing to do so.....

    Laura, CPC, CEMC

  3. #3
    Milwaukee WI
    Default Admit included in scheduled surgery
    The admission is included for scheduled surgeries. The only time you could code the initial hospital visit would be if THAT E/M was the decision for surgery.

    I disagree with Laura's example. If you are admitting the patient 2 days prior for prophylactic IV antibiotic therapy then it's still global to the surgery.
    If you are admitting the patient 2 days prior to scheduled surgery because there are signs of infection that need IV treatment - then re-schedule the surgery to a later date, and just treat the infection on this admission.

    Just my opinion.

    F Tessa Bartels, CPC, CEMC

  4. Default
    To me it depends, if the Dr is admitting the patient a few days ahead of surgery and has just ordered the IV antibiotics pre-surgery...and doesn't have need to check on that patient to reevaluate status, then may be part of pre-op. But if that Dr decides that IV antibiotics is warranted for any reason pre-op and Dr checks on patient and does re-eval chart note to determine whether patient is cleared for surgery...I think this qualifies for Inpt E&M.

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