29 Apr Medical Billing and Coding: Importance of Reporting Surgical H&P Properly
In medical billing and coding it’s important to report a history and physical (H&P) in the proper manner, depending upon as to why the H&P was performed. If not reported correctly to the insurance company or agency, you may find payments delayed, as more paperwork is filled out, filed, and reviewed.
An area of specific concern has to do with pre-surgery H&Ps. For those doctors who perform a large number of these in relationship to upcoming surgeries, improper reporting can put a big kink in your cash flow, and mean extra work for your medical billing and coding personnel, adding to your cost of doing business.
If your practice is working with a medical billing and coding service such as Medical Practice Management Resources, Inc., it’s important to communication with that company if you have any questions concerning how to go about billing for such services. Likewise, if your billing and coding group discovers problems with your H&P invoicing, they should contact you immediately to ensure that any mistakes are addressed, corrected, and not repeated.
For any H&P procedure related to an upcoming surgery the most common mistake made by practitioners has to do with their tendency to bill for the visit separate from the surgery. Although a pre-surgery H&P would normally be covered by many insurance companies and through government programs, if billed alone it won’t be recognized as being related to the upcoming procedure.
Thus, if the H&P is to clear the patient for an upcoming surgery, in most cases you should billed it as part of the bundled service related to the surgery. It should not be reported alone. In order to bill for it separately and get reimbursed it would need to satisfy the insurance company or organization’s requirements related to medical-necessity.
When to Bill Separately
There are times when a H&P done prior to surgery may be billed separately due to the fact that it does meet medical-necessity requirements. This includes anytime a patient has a new problem or complaint developing, which would involve additional work that is a not considered to be normally require for this service.
A common example would be a patient who presents symptoms related to a new, developing condition, which may in some manner alter their status in relationship to an upcoming surgery. If this occurs, the patient may need to be re-evaluated and that process may include new tests and analysis.
If a more extensive investigation of their new complaint is necessary, you should report the appropriate E/M service level. This would need to be documented and supported by the primary elements concerned with history, the examination, and your decision-making process. To establish the need for the new service and diagnosis of developing problems a medical necessity must be involved and carefully documented.
The other instance in which a H&P may be reported separately is in connection to an emergency procedure. If an emergency situation is involved, then the surgeon charged with deciding if surgery is appropriate would include in their paperwork the correct E/M service code with modifier 57 Decision for surgery added to it.
Questions- Just Ask!
If you’re a medical provider and have questions regarding medical billing and coding related to H&P services for an upcoming surgical procedure, contact Medical Practice Management Resources, Inc. We possess the experience, knowledge, and expertise that you need to ensure that your medical billing and coding is processed efficiently and effectively.