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office visit after surgery scheduled

  1. Default office visit after surgery scheduled
    Exam Training Packages

    I was wanting to see want others thought:

    Patient is seen and surgery is scheduled. The patient goes to a seminar about the procedure. The patient comes back in the office a week prior to the surgery. Questions were answered and a complete H&P was performed and will be dictated on the hopsital line. The surgical procedure was discussed including risks for infection etc. All the patients questions were answered and the patient is ready to proceed.

    Is this billable or part of the surgery global package?

    Codegirl0422, CPC

  2. #2
    Nashville AAPC Chapter
    It depends primarily on the insurance carrier and what their guidelines are. If you read your guidelines in your CPT book for Surgery, one related E/M encounter on the date immediately prior to or on the date of the procedure is included in the surgery package. So if it was 1 week prior, you should be able to bill for an E/M level. As a practice manager I made this E/M part of our package and did not charge a seperate fee to avoid any potential take backs from any insurance company.

    Hope this helps.

  3. #3
    Milwaukee WI
    Default What's the medical necessity?
    If the decision for surgery had already been made, and the patient is coming in a week prior just to get the H&P done, then what's the medical necessity for this visit? It sounds like a way to get around the global surgical package for the H&P.

    I would not code the visit. You are already being paid for the H&P service as part of the global surgical package.

    Just my opinion.

    F Tessa Bartels, CPC, CEMC

  4. Default
    I agree with FTessaBartels. There is no medical necessity for the visit. It's just a hospital requirement.


  5. Default
    Thanks everyone for your opinions. I agree with FTessaBartels & Treetoad but wanted to see what others thought. We had sent some of our visits out to be audited and one of these came back as billable and I started to question myself.
    Codegirl0422, CPC

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