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Thread: Question about HP and E/M prior to OR

  1. #1
    Join Date
    Apr 2007
    Lehigh Valley

    Default Question about HP and E/M prior to OR

    AAPC: Back to School
    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
    Join Date
    Apr 2007


    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
    Join Date
    Apr 2007
    Nashville, TN

    Default Question about the scenario

    Was the admitting Dr. the PCP or the surgeon?

  4. #4
    Join Date
    Apr 2007
    Lehigh Valley


    The admitting physician was my surgeon

  5. #5
    Join Date
    Apr 2007
    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

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