Marina Posted Wed 22nd of February, 2017 18:44:41 PM
A patient came into our office one day before their surgery. I billed code 92012 and it was denied stating it was included in the allowance for another date of service. Is there a modifier I should be using to receive payment for this day?
SuperCoder Answered Thu 23rd of February, 2017 03:10:22 AM
Greetings from SuperCoder.com!
Pre-op services are often provided for clearance for surgery.
Services included are:
- Pre-operative visits in the global surgery payment when they are provided in addition to the surgery after the decision is made to operate.
- For major procedures, this includes preoperative visits the day before the day of surgery.
- For minor procedures, this includes pre-operative visits the day of surgery.
Services not included are:
- Services of other physicians related to the surgery, except where the surgeon and the other physician(s) agree on the transfer of care.
- Visits unrelated to the diagnosis for which the surgical procedure is being performed.
- Diagnostic tests and procedures, including diagnostic radiological procedures.
Please read your documentation carefully and choose the scenario from above.
Please feel free to write if you have any concern or questions.
Marina Posted Wed 08th of March, 2017 14:13:30 PM
The reason the patient came in the day before surgery was completely unrelated to the surgery.
SuperCoder Answered Thu 09th of March, 2017 01:33:49 AM
If the reason, the patient came in the day before surgery, was completely unrelated to the surgery, then there is no need to append any modifier. Please make sure you are mapping the correct ICD-10 CM code with 92012.