Surgical H&P

There seems to be some confusion as to whether a Surgical H&P that is done more than two days before a surgery can be billed outside of the global period. I have copied the CPT® guidelines below that seem to indicate that a surgeon can bill for a surgical H&P if it is performed after the decision is made to perform the surgery as long as the H&P isn't done on the day of or the day before the surgery. What is your interpretation of this?

Thanks,

DC


If a physician conducts a history and physical (H&P) on the patient the day of or the day before surgery, on an inpatient or outpatient basis, the H&P is included in the global charge. Some disagreement may occur when the physician does the H&P after the decision to do surgery is made, but performs the H&P more than two days prior to the surgery. The CPT® guidelines indicate that the E/M (9921x) visit that occurs more than one day out from surgery can be billed outside of the global surgical package. It remains to be seen whether individual insurance companies will interpret the new guideline in this manner, or not pay for any preoperative H&P. The physician should still perform the service in a time frame that is in the best interest of the patient from a clinical perspective. This may mean that the H&P is done a week before surgery. In fact, rather than schedule the H&P two or three days before surgery, providers are wise to schedule [...]

re: Surgical H&P

http://codapedia.com/article_483_Pre-op-visits-True-or-False.cfm

Once the decision for surgery is made, a return visit to the office for a pre-op H&P is not separately reportable.