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e/m visiit prior to surgery

  1. #1
    Question e/m visiit prior to surgery
    Exam Training Packages
    Can we bill an e/m visit for a pre op H&P (more than 72 hours prior to surgery) if the decision for surgery was already made at the previous visit?

  2. #2
    North Carolina
    I'll refer you to CPT Assistant 5-2009

    Question: Are preoperative visits billable? If so, what code should be used and what is the time frame before surgery to submit this code?

    Answer: If the decision for surgery occurs the day of or day before the major procedure and includes the preoperative evaluation and management (E/M) services, then this visit is separately reportable. Modifier 57, Decision for Surgery, is appended to the E/M code to indicate this is the decision-making service, not the history and physical (H&P) alone). If the surgeon sees a patient and makes a decision for surgery and then the patient returns for a visit where the intent of the visit is the preoperative H&P, and this service occurs in the interval between the decision-making visit and the day of surgery, regardless of when the visit occurs (1 day, 3 days, or 2 weeks), the visit is not separately billable as it is included in the surgical package.


    The surgeon sees the patient on March 1 and makes a decision for surgery. Surgery is scheduled for April 1. The patient returns to the office on March 27 for the H&P, consent signing, and to ask and clarify additional questions. This visit on March 27 is not billable, as it is the preoperative H&P visit and is included in the surgical package.

  3. #3

    So what happens if the decision for surgury was made but there was no date of surgery would you still use modifer 57 or would you put it on the visit before the surgery. Plus if the surgery wasn't done by that provider would you still put the 57 on the visit?


  4. #4
    Milwaukee WI
    Default Mod 57
    Modifier 57 is needed ONLY when the decision for surgery is the day of or day immediately prior to surgery.

    You do not need modifier 57 for your decision for surgery when the scheduled surgery is more than 2 days out.

    You cannot bill for additional visits that are just for the purpose of completing the H&P, consent, etc ... these are global to the surgery.

    The reimbursement for every surgical procedure INCLUDES payment for the appropriate and necessary preoperative evaluation. NOT billable.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Does this pertains to a 10 day global as well? Thanks

  6. #6
    10 day global periods would have the 25 modifier if the visit is a separately identifiable service that goes "above and beyond" the typical pre procedure visit for the particualr procedure and it was performed on the same day of the procedure. The 57 modifier applies to major surgery with a 90 day global where the global period involves the day prior to the surgery, the surgery day, and 90 days following the surgery.

  7. Default sign consent for surgery
    What if the patient comes in to see the operating doctor to just sign the consent for surgery? The doctor goes over all the conditions that might happen during this surgery and she documents her time also. Can we still bill an em level?

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