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Need Experienced Advice

  1. #1
    Question Need Experienced Advice
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    An interventional cardiologist wants to know why he cannot charge a H&P the same day as a procedure - he wants to see the actual written "rule" on this. I am not experienced enough to answer his question satisfactorily and I have exhausted my resources trying to find this "rule" in writing somewhere - can anyone help me?

  2. #2
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    Quote Originally Posted by jperkins View Post
    An interventional cardiologist wants to know why he cannot charge a H&P the same day as a procedure - he wants to see the actual written "rule" on this. I am not experienced enough to answer his question satisfactorily and I have exhausted my resources trying to find this "rule" in writing somewhere - can anyone help me?
    This would depend on the case and whether or not you can bill the H&P. Here's a few examples that I come across with my doctors:

    If the pt is in the hosp and they are having an Acute MI and they are still in the ER, usually a Cardiologist is called in to see the pt, from my end, my docs are usually the admitting doctor, so therefor, you can bill the H&P, you would add a 25 mod to the H&P visit if a procedure like a cath is performed.

    Now if they are seen in office and the test is ordered at an office visit for a few days away, you can not bill for the H&P again the day of, unless something other than what the pt was being seen for at the hosp occurs and that changes the pt's status. I don't usually see this happen though, even though it can.

    Hope that helps
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

  3. Default
    If your interventional radiologist is actually the one making the decision to perform the procedure, then maybe he could bill the H&P. I do not see this often though. Usually what I see is a cardiologist or vascular surgeon decides the patient needs an interventional procedure and sends the patient to the radiologist. The radiologist then does a BRIEF review with the patient before performing the procedure. This brief review is included in the work value of the procedure itself.

    On page 52 of CPT Professional 2010, look under CPT Surgical Package Definition. It lists what is included in the surgical package and includes "Subsequent to the decision for surgery, one related Evaluation and Management (E/M) encounter on the date immediately prior to or on the date of procedure (including history and physical)"

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