Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

History and Physicial Question

Susquehanna Valley Posted Tue 28th of April, 2015 08:45:22 AM

Surgery Guidelines from the AMA CPT book states for the first part of the CPT Surgical Package Definition:

Evaluation and Management (E/M) services subsequent to the decision for surgery on the day before and/or day of surgery (including history and physical)

(This is the only portion of the surgical package I have a question about.)

THE PART THAT STATES DAY BEFORE AND/OR DAY OF SURGERY (INCLUDING H&P)... WHEN CAN I BILL FOR H&P AND WHEN I CAN'T BILL FOR IT/ ALSO, WHEN GLOBAL DAYS BEGIN. I BELIEVE THAT GLOBAL DAYS BEGIN DAY BEFORE SURGERY AND BEGIN COUNTING 90 DAYS THE DAY AFTER SURGERY-BUT I WAS TOLD DIFFERENT THE OTHER DAY. I WANT TO BE SURE I AM BILLING CORRECTLY.

My physician will often present surgery as an option and allow the patient to go home and think about his/her option, discuss with spouse or employer.

Than if the patient chooses to have surgery we schedule another appointment to perform the H&P... this can be 2-3 week before the surgery [not the day before surgery as it states in the definition].

I am looking for guidelines specific to the history and physical and cannot find them. AGAIN, MY SPECIFIC QUESTION HAS TO DO WITH EXACTLY WHEN GLOBAL BEGINS, I WAS TOLD THAT IF DECISION FOR SURGERY, FOR EXAMPLE WAS 1 MONTH BEFORE, ONCE THE DECISION FOR SURGERY IS MADE, THE OTHER VISITS AFTER ARE NOT CHARGEABLE.

WHAT CAN I BILL AND WHAT CAN I NOT BILL IN RELATION TO THE H&P...

Scenerio 1 [how I understand]
Physician gives surgery option to patient "today", Patient choses to have surgery "today" and H&P is performed at this visit~I do bill for this visit.

Scenerio 2
Physician gives surgical option to patient "today", patient goes home to think about it. He/She decides to have the surgery. Returns to office for the H&P-I bill this.

Scenerio 3
Same as in scenario-patient is presented with surgery and patient chooses to have the surgery. Patient returns for his H&P. I DO NOT BILL FOR THIS H&P BECAUSE THE DECISION FOR SURGERY WAS MADE AT THE LAST APPOINTMENT.

I do appreciate any clarification you can shed on this for me.

Also, can you show me where I can find specific guidelines in writing in relation to this.

Thanks,

SuperCoder Answered Wed 29th of April, 2015 02:19:46 AM

For a procedure with a global period of 90 days, if an E/M service is performed one day before or on the same date of service as a major surgical procedure, it is included in the global payment for the procedure and is not separately reimbursable unless the decision to perform surgery was made during the visit. If the decision to perform surgery was made during the E/M visit, the E/M would be separately reimbursable with modifier 57 appended to the code.

Related Topics