Amc Posted Wed 25th of July, 2012 15:48:27 PM
can a gastro bill for a consultation before a procedure?
SuperCoder Answered Wed 25th of July, 2012 17:42:10 PM
Yes, as long as you are the surgeon who is providing an initial evaluation or consultation in which the decision to operate is made. In this scenario, the H&P or consultation is not included in the surgical package and will be paid separately.
1.You are the admitting or consulting physician seeing the patient for the first time (performing an initial evaluation or consultation); and
2.You are making the ultimate decision to perform the procedure the day of the procedure.
You must append a modifier 25 or 57 to the H&P or consult code. Do not append the modifier to the procedure code. If you do not append the modifier, the insurance carrier will consider your H&P or consult included in the payment for the procedure (surgical package).