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E & M on day of surgery

  1. #1
    Default E & M on day of surgery
    Medical Coding Books
    I'm not really sure I understand what's included in E & M before surgery and what is included in the preoperative workup of a procedure.

    For example, suppose I see a patient in the office who has rectal cancer and needs a infusion port for chemo. I bill the office visit and subsequently the port.

    Suppose one of my partners (who doesn't do ports or a med oncologist for that matter) sends me someone for a infusion port and to save the patient time I just tell them that we'll schedule it and I'll see them in the preoperative area and discuss it with the patient then.

    Can I bill the preoperative visit in the holding area with a 57 modifier? I have the same discussion and exam either way.


  2. #2
    Milwaukee WI
    Default Who makes the decision for surgery?
    If YOU are evaluating a patient and make the decision that the patient needs a procedure, you can code the E/M (with decision for surgery modifier if you are doing procedure right away).

    If a patient is sent to you to have the procedure done (i.e. someone else has already determined the need for the procedure), then the E/M you perform is bundled.

    The payment for all procedures INCLUDES necessary E/M prior to procedure.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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