ED Coding & Reimbursement Alert - 2022 Issue 8
Reader Questions: Look to Patient Insurance Status for Clue on Billing Second Visit
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Article Overview
This article answers a billing question about whether a follow-up office/outpatient evaluation and management visit before surgery can be separately reported or whether it is considered part of the surgical global period. It focuses on the difference between Medicare-style global surgery guidance and situations where a patient’s condition changes between visits, making the issue relevant to coders, billers, and compliance staff handling preoperative services.
Why This Topic Matters
Preoperative visit reporting can affect claim submission, compliance, and whether a service is bundled into the surgical package. Understanding when payer rules and documentation support a separate E/M service helps reduce denials and avoid improper billing.
Article Sections
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Question
The reader describes a scenario involving a planned surgery, a return visit shortly before the procedure, and uncertainty about whether the second visit can be billed separately.
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Answer
The response discusses general global surgery guidance, the role of payer policy, and how changes in the patient’s situation may affect whether a second preoperative visit is reportable.
What You Will Learn
- How payer policy can affect reporting of preoperative visits
- When a second office/outpatient E/M visit may be considered part of a surgical package
- Why changes in the patient’s condition matter for billing decisions
- What documentation considerations are relevant when circumstances change between visits
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physician practices
- Revenue cycle teams
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