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Started by l.a.coder at 12-14-2005 10:37 PM. Topic has 3 replies.

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   12-14-2005, 10:37 PM
l.a.coder is not online. Last active: 4/12/2007 6:55:48 AM l.a.coder

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Joined on 12-15-2005
Posts 20
Office Visit versus Pre-op visit
How many days prior to a scheduled surgery does a patient need to come in to be considered a regular office visit versus a pre-op visit? Thanks.
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   12-16-2005, 4:29 AM
OrthoPinn is not online. Last active: 12/19/2005 10:29:12 PM OrthoPinn

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Joined on 12-10-2005
Dallas, GA
Posts 4
Re: Office Visit versus Pre-op visit

Well, let me give it a try.....Major surgery includes:  All preoperative visits (in or out of the hospital) by the surgeon beginning the day before surgery.  So if the patient was seen 2 days before surgery, then you could bill an E&M.  If the patient was seen the day of or day before surgery and that is when the decision for surgery was made, then the -57 modifier applies (decision for surgery). Otherwise, if the surgery was planned, say a week in advance, the patient comes in for preop 2 days before the surgery, you can charge an E&M, if seen 1 day before surgery, you cannot charge an E&M unless the above modifier rule above applies.  Hope didn't make this too complicated.  Anyone else have a simpler way of explaining....

 

 

 

 


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   12-16-2005, 6:15 PM
l.a.coder is not online. Last active: 4/12/2007 6:55:48 AM l.a.coder

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Re: Office Visit versus Pre-op visit
Your explanation was very clear and easy to understand. Thank you.
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   12-29-2005, 3:00 PM
scuyler9 is not online. Last active: 7/20/2006 2:29:22 AM scuyler9

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Joined on 12-13-2005
CT
Posts 11
Re: Office Visit versus Pre-op visit
Hi there. The response given to you by orthopin (?) was technically correct, HOWEVER, the true answer to that question really depends upon the insurance carrier. Not all carriers recognize pre-op days as part of the global package and these are billed out as office visits. Wouldn't it be nice if all carriers were on the same page!
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