May a physician bill a consultation prior to performing a minor surgical procedure?
No, not when the patient is referred specifically for the procedure. The initial evaluation is included in the allowance for a minor surgical procedure. To determine what procedures are “minor surgical”, providers may reference the Medicare Physician Fee Schedule Data Base (MPFSDB) that lists the postoperative periods that apply to each surgical procedure. The payment rules for surgical procedures apply to codes with entries of 000, 010, 090, and, sometimes, YYY. Codes with “090” are major surgeries. Codes with “000” or “010” are either minor surgical procedures or endoscopies. Codes with “YYY” are carrier-priced codes, for which carriers determine the global period (the global period for these codes will be 0, 10 or 90 days). Visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable, necessary service is also performed and documented (and indicated on the claim form by a mod
No, not when the patient is referred specifically for the procedure. The initial evaluation is included in the allowance for a minor surgical procedure. To determine what procedures are “minor surgical”, providers may reference the Medicare Physician Fee Schedule Data Base (MPFSDB) that lists the postoperative periods that apply to each surgical procedure. The payment rules for surgical procedures apply to codes with entries of 000, 010, 090, and, sometimes, YYY. Codes with “090” are major surgeries. Codes with “000” or “010” are either minor surgical procedures or endoscopies. Codes with “YYY” are carrier-priced codes, for which carriers determine the global period (the global period for these codes will be 0, 10 or 90 days). Visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable, necessary service is also performed and documented (and indicated on the claim form by a mod
