Forum - Questions & Answers

Apr 16th, 2015 - ARlamb1972 1 

Billing Inpatient consult and procedure

I am always stumped on this depending on the payer, If our Doctor does a consult on an in-patient at hospital and the next day surgery is performed say for example CPT-47562, should we be paid for both consult and surgery if I apply the 57 modifier?

Apr 16th, 2015 - petunia 195 

re: Billing Inpatient consult and procedure

As long as the decision for surgery was made during that consult and the surgery has a 90 day global, you would be correct. In this case 47562 is a 90 day global and the 57 would apply as long as the consult supports that decision.

Apr 17th, 2015 - ARlamb1972 1 

re: Billing Inpatient consult and procedure

Great Thank you. Now what about if our doc does an in patient consult as well as an I&D-CPT-10060/10061 on the same day? My understanding is to append 25 modifier to the consult, but sometimes I second guess this because I have read not to add 25 modifier just to get paid! But if the doctor is doing the consult and procedure same day I think he should be paid for both. Am I correct to always bill these situations with 25 mod on the consult?



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