decisionhealth Newsletters, Part B News - 1999 Issue 10 (October)
Bill extra H&P prior to surgery, but medical necessity is key
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Article Overview
This article discusses preoperative evaluation and management billing in the context of surgery, focusing on when a history-and-physical service may be considered part of the surgical global package versus separately billable. It is aimed at coders, billers, auditors, and physician practices that handle pre-op workups and need to understand Medicare-related timing, documentation, and modifier considerations. The piece explains the general issue, the role of medical necessity, and the importance of timing relative to surgery without providing a coding shortcut.
Why This Topic Matters
Preoperative visits can affect reimbursement and compliance, especially when multiple assessments occur before a procedure. Understanding whether an encounter is included in the global surgical package helps practices document appropriately and reduce billing risk.
Article Sections
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Preoperative H&P billing scenario
Introduces a situation involving multiple preoperative history-and-physical services around a planned surgery. It frames the billing question and the practice setting in general terms.
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Medicare global period considerations
Summarizes the timing concepts discussed in relation to Medicare’s surgical package and preoperative periods. The section focuses on broad global-period context and how timing affects billing considerations.
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Medical necessity and documentation
Explains the role of documentation in supporting a separate service before surgery. It addresses the importance of establishing a legitimate clinical purpose for the encounter.
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Timing and modifier considerations
Discusses the significance of when the visit occurs relative to admission and surgery. It also notes that modifier use may be relevant in the described scenario.
What You Will Learn
- How preoperative history-and-physical services are viewed in relation to surgical billing
- Why medical necessity documentation matters for an additional pre-op visit
- How timing relative to surgery affects the billing context
- When modifier considerations may arise for a preoperative evaluation and management service
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Practice administrators
- Physician office staff
- Audit and reimbursement professionals
Modifiers Discussed
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