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Thread: Is this visit bundled into surgical package?

  1. #1
    Join Date
    Apr 2007
    Seattle First Hill

    Default Is this visit bundled into surgical package?

    AAPC: Back to School
    Doctor put a patient on the surgery schedule who he had never seen before. I believe the patient had previously sent their films down for him to review. The patient came into the office the same day the surgery was scheduled. Is the office visit billable with a -57? Or is it considered a pre-op clearance?

    Thanks in advance!

    Kirsten, CPC

  2. #2


    Are you saying the Doc put the patient on the surgery schedule even prior to him seeing the patient?

    I cant imagine a Doc planning surgery on a patient he has never seen so did he book the surgery as a proactive measure just to block the surgery time?

    Regardless, if the decision of what surgery was appropriate and the decision to acutally proceed with the surgery was made during the office visit, then yes you can code the E&M with a mod -57

    If the surgery was a done deal at the time of the visit, meaning "your PCP sent you to me to repair your hernia", then the office visit would be pre-op and would be included in the global

    The only other option to code the E&M is if the patient presented the day of the surgery and there is medical necessity to re-evalute the patient's condition. For example, patient comes in saying he has been throwing up for 2days or his home BP reads are all elevated.

  3. #3
    Join Date
    Apr 2007
    Seattle First Hill


    The patient was coming to our clinic from Canada, so in order to better accomodate them, he booked a surgery slot the same day as the office visit. I feel like he should be able to charge for an E/M visit with a -57. Our manager, however, told the patient it was not billable so we're going to have to eat it regardless. In case this happened again in the future, I wanted some confirmation....

    Thanks so much for your reply- it helped tremendously!!

    Kirsten, CPC

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