Page 3 of 3 FirstFirst 123
Results 21 to 23 of 23

Surgical package

  1. Default modifier 56
    Medical Coding Books
    I don't believe this is correct. The PCP's office has only been asked for medical clearance on a surgery patient. The surgeon's office sets up all the tests, ekg, lab work, etc. The surgeon's office does all that, not the PCP. The PCP is simply doing an office visit 2 wks prior to the surgery date for medical clearance. That is an E/M visit, not a pre-op visit. The surgeon's office does all the work-up for the patient, makes all the arrangements. The surgeon should be paid for pre-op.
    NGS Medicare states this is incorrect and a non-compliant practice.
    If the PCP was handling all the Pre-op work, then I may consider agreeing with mitchellde, but they are not and should not be, since the surgeon's office is handling all that.

  2. #22
    Location
    Columbia, MO
    Posts
    12,844
    Default
    Quote Originally Posted by ortho65 View Post
    I don't believe this is correct. The PCP's office has only been asked for medical clearance on a surgery patient. The surgeon's office sets up all the tests, ekg, lab work, etc. The surgeon's office does all that, not the PCP. The PCP is simply doing an office visit 2 wks prior to the surgery date for medical clearance. That is an E/M visit, not a pre-op visit. The surgeon's office does all the work-up for the patient, makes all the arrangements. The surgeon should be paid for pre-op.
    NGS Medicare states this is incorrect and a non-compliant practice.
    If the PCP was handling all the Pre-op work, then I may consider agreeing with mitchellde, but they are not and should not be, since the surgeon's office is handling all that.
    It can be modified to show partial with the 52 so it would have both the 56 and the 52 it is not noncompliant.

    Debra A. Mitchell, MSPH, CPC-H

  3. #23
    Question
    All of us obviously have some very interesting opinions on this matter. Which really proves how difficult coding can be - when other experienced CPCs can't completely agree on a subject. I am extremely glad this subject came up because I never even considered billing pre-op this way until now - BUT - being the suspicious/paranoid coder that I am, I need some kind of documentation to validate either case. I haven't found any concrete evidence to say that you can't bill a sx code with mod 56, and I haven't found any evidence to support not billing it either. I have, however, found documentation to support billing the office visit codes. I think until someone can provide the documented rules for billing pre-op, it all becomes speculation and opinion.
    I would like to clarify with ortho65 if possible - If our family practice group performs all the xrays, ekgs, labs, and evaluation for the pre-op does this qualify as the pre-op care? Or is there another component to this that I am not aware of? I just want to make sure I understand the surgeon's side of the workup. As I posted earlier, this could really affect our billing - so we need to move carefully on this.
    Thank you.

Page 3 of 3 FirstFirst 123

Similar Threads

  1. Global Surgical Package
    By lhardin0621 in forum Auditing General Discussion
    Replies: 0
    Last Post: 01-22-2013, 08:17 AM
  2. Surgical Package and E/M
    By dballard2004 in forum E/M
    Replies: 8
    Last Post: 03-08-2011, 06:49 AM
  3. Outside of the Global Surgical Package?
    By 1071471 in forum E/M
    Replies: 2
    Last Post: 04-22-2010, 01:08 PM
  4. Surgical Package
    By limit006 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 05-12-2008, 10:47 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.