Results 1 to 5 of 5

Question about HP and E/M prior to OR

  1. #1
    Default Question about HP and E/M prior to OR
    Clearnace Sale
    Good afternoon!

    Not sure what to do with this scenario....the patient is admitted one day prior to surgery; however, during the admission and throughout that entire day the patient continued to refuse surgery and only wanted nonoperative treatment with antibiotics for diverticulitis. The next day, the patient was not responding to the IV antibiotics and therefore, surgery was recommended, and the patient finally consented. How would the HP be coded out as with a 57 modifer or no modifier, and could I bill out the follow up hospital visit with a 57 modifier or is this not billable??

    Thanks for the help!

  2. #2
    Personally I would only bill for the admit, no modifier, since the decision for surgery was already made but delayed due to non-medical patient issues and I would not bill for the subsequent day at all.

    Obviously they had to alter their orginial treatment plan and could have possibly not done surgery at all so I feel comfortable billing out the admit. The subsequent care day is included in the global period.

    Just my opinion,

    Laura, CPC, CEMC

  3. #3
    Default Question about the scenario
    Was the admitting Dr. the PCP or the surgeon?

  4. #4
    The admitting physician was my surgeon

  5. #5
    Milwaukee WI
    Default Admission for scheduled surgery
    If the surgery was scheduled previously, then the decision for surgery was made previously ... i.e. the SURGEON's decision was made previously. If the surgery had proceded as originally planned you would not bill for the H&P.

    So ... I would not bill out the Initial Hospital Visit in this case. I know the patient made life difficult, but the preoperative care is included in the RVUs for the procedure. The only way around it if is the decision for surgery is made in those 48 hours prior. If I'm understanding your post correctly, that is not the case here.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

Similar Threads

  1. E/M prior to screening
    By in forum Gastroenterology
    Replies: 1
    Last Post: 12-12-2015, 11:53 AM
  2. prior vs history of
    By weina in forum Diagnosis Coding
    Replies: 2
    Last Post: 05-30-2012, 07:46 AM
  3. E/M prior to surgery
    By ymclark in forum General Surgery
    Replies: 0
    Last Post: 05-28-2010, 10:59 AM
  4. Prior Authorization Question
    By sevolution in forum Employment General Discussion
    Replies: 2
    Last Post: 12-17-2009, 05:09 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.