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Thread: Hospital visits + Surgical Procedure

  1. #1

    Red face Hospital visits + Surgical Procedure

    AAPC: Back to School

    I am going to start billing for a general surgeon. I know about the Surgical Packages. I just don't find anything specific as to what to report in the claim form.

    This physician reports a 99223 and 99233X4 plus the surgical procedure for example a Hartmann w/Colostomy CPT 44143.

    How do I bill for this? Do I only bill for the surgical procedure? Or do I bill the hospital codes in addition to the surgical procedure? on the same claim form?

    In other words, do I bill only the 44143


    Do I bill
    DOS 1-99223
    DOS 1-44143
    DOS 2-99233
    DOS 3-99233
    DOS 4-99233
    DOS 5-99233

    Please help!

  2. #2
    Join Date
    Apr 2007
    virginia beach, va


    Hi there:

    You can bill DOS 1-99223 with a decision for surgery modifier (57)--- if in fact this visit did lead to the decision to perform the surgery. If this was not the case then, you can not bill for the initial hospital care separately.

    As for the subsequent days, they are included in the surgery(44143) which has a 90 day global period.

    Hope this was helpful!!!


    Gena Alexander-Fortune, CPC, CGSC

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Global surgical package

    Was this a scheduled hospitalization for the purpose of this surgery? If Yes, then you probably had an office visit earlier where the decision for surgery was made, so the initial hospital visit (99223) is NOT billable.

    If this was an unplanned hospitalization and the surgeon's initial visit resulted in the decision for surgery, then you need to use a -57 modifier on your E/M code 99223.

    The subsequent hospital visits (as well as any office visits within 90 days of the date of surgery) are all included in the global surgical package. Non billable.

    F Tessa Bartels, CPC, CEMC

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