need to clarify...

I am still trying to pin down the "decision for surgery" as pertains to elective surgeries, and at what point additional e/m visits are considered global.

Is it when the doctor tells the patient "this surgery would help you, if you would like to do it"? Or is it when the patient says "OK, I do want to do that surgery". Or when the surgery is scheduled? Or when the consent for surgery is signed?

I would sure love to hear some others' thoughts on this. I haven't been able to find any sources that give guidance on the subject.

need to clarify...