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Thread: Discuss Surgery

  1. #1

    Default Discuss Surgery

    AAPC: Back to School
    My doctor would like to bill for talking with a patient face to face about cataract surgery. Does anybody know if you can do this and what the code would be? Thanks!

  2. #2
    Join Date
    Apr 2007
    Kingsport, TN


    I would bill an E&M with a modifier of 57 if the decision for surgery was made during the visit you are referring to. Now, if the doctor brings them back in for discussion AFTER the decision was made, then you cannot bill a visit as this would be included in the surgical package. Hope this helps.

  3. #3


    You would bill based on time. If the physician examined the patient during the visit, then the counseling would have had to take up a majority of the visit to bill based on time. If the physician met with the patient and all they did was talk about the upcoming surgery, then the total time would be used to bill based on time.

    The physician would have to document something like, "I spent 60 minutes with the patient discussing his upcoming cataract surgery. I explained the risks, what to expect post-operatively, etc etc." If this is an established patient, then you can bill 99215. (If the physician actually did an exam too, then in addition to documenting the history, exam and MDM, he would have to write something like, "I spent 60 minutes with the patient. Over 50% was spent counseling the patient on his upcoming cataract surgery. We discussed....").

    You only add the -57 modifier if this visit was within the 90-day global period - in other words, the surgery was later that same day or the very next day - otherwise it is not needed.

    Lisi, CPC

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default Agree with Michelle

    I agree with Michelle.

    If the decision for surgery was made at a prior visit, and this is merely a meeting to go over what will happen (risks, benefits, postop care, etc) in surgery, then this is global to the surgery. No E/M billable.

    If this encounter resulted in the decision for surgery, then you can bill it. (If surgery will be within 48 hours, add -57 modifier; if surgery more than 48 hours after no modifier needed.) You could use time spent in counseling/coordination of care as a deciding factor in determining the level of visit IF the counseling/coordination of time was more than 50% of the total time spent face-to-face with patient.

    F Tessa Bartels, CPC, CEMC

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