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H&P's on the same day as surgery

  1. Default H&P's on the same day as surgery
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    We were wondering, if a physician does an H&P and decides he's taking the pt to the OR that same day, in fact the procedure was done on the same day in the OR, is it billable?

    In normal situations, if the H&P was being done at least a week before the surgery, we would code the E/M w/mod 57, however we're hearing that this particular H&P would not be billable.....can someone please clarify....Thanks!

  2. #2
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    Kansas City, MO
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    431
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    If a visit was done, and then the actual decision to operate was made then, you can bill it with the modifier -57. (-25 for minor procedures) Make sure it is documented to reflect this.
    For the visits done a week or so before the surgery you don't need the -57. While it probably won't hurt your claim, this just isnt the right use for it. 57 modifier is meant to unbundle an E/M from the global surgical package.

  3. #3
    Location
    Kansas City, MO
    Posts
    751
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    If you have access to the CPT Assistant May 2009 there is a very good article on this very issue of the Pre-Op H&P. I have used to help educate my providers.

    The H&P is part of the Global Surgical Package once the decision for surgery is made. In our practice the Decision for surgery may be made a month ahead of time, but that is too early to do the H&P. So the physician may have the patient come back in a week or a couple day before the actual surgery for the H&P, and this is not billable.

    LindaLouh is correct that the -57 is only used if the Decision for Surgery is made the day before or day off a surgery with a 90 day global period.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  4. Default
    What CPT code are you using for the H&P no charge visit?

  5. #5
    Location
    Kansas City, MO
    Posts
    751
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    There are actually various ways to handle this. Some systems will allow the use of a dummy code or use a regular E/M code with your own internal modifier that will keep the charge from being billed out. Some people even use S0260 in their system with a $0 to keep it from being billed. It really depends on how the practice wants to handle and track this service.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  6. Default
    yes you can bill the H&P with modifier 57 appended to the CPT code.

  7. Default
    Thanks for all the responses!

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