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subsequent hospital visits

  1. #1
    Default subsequent hospital visits
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    My doctor saw a patient on 3/18 for an inpatient consult. On this visit it was decided to do surgery on 3/23. He then saw the patient on 3/22 & 3/23, complications arose and surgery couldn't be done. He then saw the patient on 3/24 and scheduled surgery for 3/29. On 3/29 he saw the patient and surgery was cancelled still due to complications. There was another visit on 3/30 still stating that surgery will need to be done but no clear plan as to when. On 4/8 the pt. was seen again and it was decided then to go ahead with the surgery. Finally on 4/9 the surgery was completed. this was all during an in patient stay. My question is can I bill all dates, some dates or just the inital one on 3/18 because that is the actual day decision for surgery was made? Any help with this is appreciated.

  2. #2
    Default Bill all or most of them...
    I'd bill all of them up to 4/8 and even then, maybe 4/8 with a 57 modifier depending on your documentation.

    According to Medicare's view of the global surgical package:

    "Preoperative visits after the decision is made to operate beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures" are included.

    By your example, the only one that would be included is the 4/8. The others are all well before the day before or of the major surgery.

  3. #3
    Thank you so much for the information.

  4. #4
    Parkersburg, West Virginia
    Why would the -57 modifier still not go on the initial consult visit, since this is when the decision was made for surgery?

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