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consultation

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.

Criteria:
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).

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