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H&P on the same day as a preschdules procedure

  1. #1
    Location
    grand canyon(PHX)
    Posts
    24
    Default H&P on the same day as a preschdules procedure
    Medical Coding Books
    PLEASE help

    patient comes in and is seen by a cardiologist the decision is made to do a cath
    the next week the patient has their procedure and a H&P is done
    the patient then goes home the next day.

    what is billable

    noridian is the medicare Fiscal Intermediary

    there was no change in the patient statues and the there is no admitted to Inpatient or observation. there is also no complication and this is standard for all pre schedule caths

    please advise and provide resource if available to support your point

    thx in advance
    Robert A Kiesecker CPC CCC CPC-I

  2. Exclamation Anyone?
    I am curious too? Does anyone know this?

  3. #3
    Default
    First E/M should be billed with modifier -57 "decision for surgery". I usually bill and H&P with, for example V72.83 but it will be denied and nobody should expect to get payment for H&P. There is no medical necessity for second visit.

  4. Default
    Quote Originally Posted by arme2783 View Post
    First E/M should be billed with modifier -57 "decision for surgery". I usually bill and H&P with, for example V72.83 but it will be denied and nobody should expect to get payment for H&P. There is no medical necessity for second visit.
    I agree. The second visit as the decision for the cath is already made, will be bundled into the procedure.

    The only way the H&P/Consult will be billable is if the patient came in with another complaint (chest pain) and the decision was made for the cath at that time.

  5. #5
    Default
    Correct. The E/M with the decision for cath is billable but the second H&P visit is not billable. Why is the H&P not done at the time of the first visit? And the 57 modifier is only needed the day before or day of a major procedure.

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