Report Presurgical H&P With Caution
January 29th, 2013
History and physicals before surgery can be potholes in the road for reimbursement if reported incorrectly. Watch the circumstances under which the physical is performed to prevent a fiscal flat tire.
In most cases, if the surgeon performs a history and physical (H&P) to clear a patient for a scheduled surgery, you should not report a separate service. An H&P is a routine, standard procedure prior to surgery, and is separately reimbursable only if the service satisfies your payer’s medical-necessity requirements. In practical terms, a presurgical H&P is a bundled service, unless the patient presents with a new chief complaint that requires work above and beyond that normally required for such a service.
For example, a patient may develop a new problem or otherwise have had a significant change of status in the days before his surgery, which would require the surgeon to perform a more extensive evaluation. In such a circumstance, you may report the appropriate E/M service level, as supported by the key components of history, exam, and medical decision-making. Any new diagnosis or patient problems must be documented to establish medical necessity for the visit.
The rules change for services provided within 24 hours of an unscheduled and/or emergency procedure. In these cases, a surgeon making the decision for surgery during the visit would report an appropriate E/M service code with modifier 57 Decision for surgery appended.
Tags: decision for surgery, HP, modifier 24, modifier 57, presurgical clearance