Intra-Operative Consultations

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March 21, 2013

Question:

I read with interest your coding coach question on Intra Op Consults. We love going to the coding courses Mary LeGrand presents for th ACS. I think I understand why the intra-op consultation was not reportable when the surgeon was called in just to repair the enterotomy. Recently our surgeon was called in for a consultation on a large intra-abdominal tumor case. The operative surgeon needed an opinion about what he was seeing intra-operatively and whether to proceed or not. Our surgeon scrubbed in, evaluated the patient (problem focused exam) and spent time discussing the case with the surgeon. They both agreed on the plan of care and the primary surgeon then requested our surgeon to assist because of the complexity. The surgeon’s note is well documented for the assessment and discussion and the surgeon’s note documents similar discussion and the need for our surgeon to stay on and assist. Can we bill an intra-operative consultation in this scenario?

Answer:

Yes, this intra-operative consultation is separately reportable. Append modifier 57 as you will be reporting the services as an assistant that has a ninety day global period. Be prepared for a possible denial and need to appeal the E&M being denied as inclusive. It sounds as though you have the documentation to support reporting the service and appealing. Thanks for your support of the ACS sponsored courses!