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History & Physical

  1. Default History & Physical
    Medical Coding Books
    Hello. Can anyone tell me where on the CMS website would I find the guidelines regarding history and physicals before an outpatient procdure? Our office policy is that we have a history and physical on file between 1 and 30 days before an outpatient injection. I am wanting to know if this is actually Medicare's guidelines.

    Thank you!

  2. Default
    The reason you can't find it is that there is no Medicare requirement from a history and physical 1-30 days prior to a minor outpatient procedure. In fact, over 15 years ago, the our carrier's Medicare Medical Director published a statement saying that an office visit and procedure can be billed on the same date of service with only one dx if the decision for the procedure was made that day.
    Sherry Miller, MBA/HCM, CPC, CEMC
    Epic Management, LP

  3. #3
    Default
    Quote Originally Posted by ericaewton@gmail.com View Post
    Hello. Can anyone tell me where on the CMS website would I find the guidelines regarding history and physicals before an outpatient procdure? Our office policy is that we have a history and physical on file between 1 and 30 days before an outpatient injection. I am wanting to know if this is actually Medicare's guidelines.

    Thank you!
    What you want starts on page 90, and goes through about page 105, of this: http://www.cms.gov/manuals/downloads/clm104c12.pdf

    You need to look into stuff on "Decision for surgery" and the routine pre-operative visits that are part of the global surgical package.

    Hope that helps!

  4. #4
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    Default
    Quote Originally Posted by ericaewton@gmail.com View Post
    Hello. Can anyone tell me where on the CMS website would I find the guidelines regarding history and physicals before an outpatient procdure? Our office policy is that we have a history and physical on file between 1 and 30 days before an outpatient injection. I am wanting to know if this is actually Medicare's guidelines.

    Thank you!
    I don't believe CMS has anything that specific. That is more specific office or facility policies. What kind of injection are you referring to? I know hospitals and outpatient surgery centers have specific guidelines regarding timelines for history and physicals before procedures. If is an injection done in the office, then it just follows whatever guidelines your providers set up for good patient care and to establish medical necessity.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  5. #5
    Default *I need to clarify...
    Quote Originally Posted by ajs View Post
    I don't believe CMS has anything that specific. That is more specific office or facility policies. What kind of injection are you referring to? I know hospitals and outpatient surgery centers have specific guidelines regarding timelines for history and physicals before procedures. If is an injection done in the office, then it just follows whatever guidelines your providers set up for good patient care and to establish medical necessity.
    *CMS doesn't require you to do a pre-op exam, to my knowledge (that's more of a quality of care/malpractice safeguard, really), but all of the information that they do have in regards to reporting pre-op visits, is on the link I listed...

    I saw how my post could be confusing...sorry...

  6. Default
    Conditions of Participation (CoPs) are were you will find the info. PPS hospitals are required 30 days H/P priot to procedures. The surgeon before any procedure needs to doc acceptence of the patient. CAH do not have this defined as well... it is recommended to be completed within 30 days. The Medical Staff bylaws also play a huge part in defining their actual processess. You should have a Medical Staff policy as well that defines this.

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