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Same day consult and right heart cath

Riyaz Posted Tue 22nd of January, 2013 16:45:32 PM

Can you bill for consult and heart cath done on the same day if heart cath was a planed pre-op procedure to AAA repair?

SuperCoder Answered Tue 22nd of January, 2013 20:25:04 PM

It’s not quite clear what the consult was for and when the decision was made to perform each service. It’s also important to determine whether the payer in question accepts consult codes or requires you to use regular E/M codes instead.

But in general terms, heart caths typically have a 0-day global. AAA repair codes typically have a 90-day global.

For those payers that follow Medicare rules, review Medicare Claims Processing Manual, chapter 12, section 40.2.A.4 (www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf).

If the visit in question led to the decision to perform the AAA repair, then you may report it separately using mod 57: “Evaluation and management services on the day before major surgery or on the day of major surgery that result in the initial decision to perform the surgery are not included in the global surgery payment for the major surgery and, therefore, may be billed and paid separately. In addition to the CPT evaluation and management code, modifier “-57” (decision for surgery) is used to identify a visit which results in the initial decision to perform surgery.”

If the visit in question led to the decision to perform the heart cath, then consider this rule: “The 57 modifier is not used with minor surgeries because the global period for minor surgeries does not include the day prior to the surgery. Moreover, where the decision to perform the minor procedure is typically done immediately before the service, it is considered a routine preoperative service and a visit or consultation is not billed in addition to the procedure.”

But if you’re talking about a distinct E/M, then you may be able to report it separately.

Riyaz Posted Thu 24th of January, 2013 20:45:13 PM

Both procedures, AAA and right heart cath where planed at time of consult with different physician. Our physician was just to perform right heart cath and his consult report doesn't mention anything distinct.

SuperCoder Answered Fri 25th of January, 2013 22:03:02 PM

Based on that information, it sounds like the service is most likely a routine preoperative service that payers may not consider separately payable.

Riyaz Posted Fri 25th of January, 2013 23:17:02 PM

Thank you.

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