GYN question. Is second visit part of global?

5/18 Pt was seen by MD with vaginal bleeding. MD makes decision to do surgery & performs Pelviscopy with lysis of adhesions &/or excision fulguration of endometriosis. E&M visit billed (99245)

5/20 Pt had video pelviscopy, lysis of adhesions, aspiration of the cul-de-sac, D&C & hysteroscopy. Documents in OR note: Outlook for future: Hysterectomy. Will discuss with pt whether to keep or remove ovaries.

6/8 HPI states: "Pt here today for pre-op eval for hysterectomy & has nothing to do with her postop pelviscopy eval. Repeats full ROS & comprehensive exam & counsels pt on upcoming surgery.
Is this visit billable? Or is it the decision for another surgery?

Thanks!

Comments

  • edited May 2017
    Michele:

    This depends on the global days assigned by the plan for the pelviscopy / fulguration procedure.

    The physician has the right to re-evaluate a patient after a procedure and create a treatment plan.

    Review the CPT that was used to bill the procedure. If it has a 10 day global, then yes the 6/08 DOS can be billed without a modifier. If the procedure has a 90 day global, then modifier -79 could be appended to the E/M service, but be certain the revised diagnosis is used when submitting the claim - as this distinguishes it as an updated reason for seeing the patient.

    Karen A. Hurley, BS, CMM, CPC, CNA
    President, HPMSI
    PO Box 409
    Parrish, FL 34219
    Tel: (941) 776-4822
    Fax: (240) 368-0059
    Web: www.hpmsi.com

    Since 1996, Celebrating 20 years of Service to Physicians

  • edited May 2017
    One more thing.....if the 6/08 visit is within 24-48 hours of the surgery date (each plan is different), then you may need modifier -57, (only or additional).

    Karen A. Hurley, BS, CMM, CPC, CNA
    President, HPMSI
    PO Box 409
    Parrish, FL 34219
    Tel: (941) 776-4822
    Fax: (240) 368-0059
    Web: www.hpmsi.com

    Since 1996, Celebrating 20 years of Service to Physicians

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