# Preoperative consult and new problem



## smwermter (Sep 29, 2009)

I am coding a preoperative consultation (which does meet the reason, request and reply criteria) but the physician states that the patient is in for 2 reasons, the consultation and a new problem of anxiety which she dictates a seperate note on.  My question is, is it appropriate to code a consultation E/M with a 25 modifier for the preop and an office call E/M for the anxiety...or would the consult code cover the whole visit?


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## FTessaBartels (Sep 29, 2009)

*Consult*

I'm guessing that the anxiety is realted to the upcoming surgery.  Your consult will cover both problems, but you would take your new problem into account when determining MDM (problem points).

F Tessa Bartels, CPC, CEMC


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## smwermter (Sep 29, 2009)

Thank you so much for your help!


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## smwermter (Sep 29, 2009)

The anxiety is not related to the surgery...does this change your advice on this one?  I think the consult is all I should be coding, but I keep second guessing myself.


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## Lisa Bledsoe (Sep 29, 2009)

I would say that you have to incorporate the new problem into the pre-op clearance consult.  Your additional E/m -25 will just be denied.


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## LLovett (Sep 29, 2009)

I agree, this should only be the consult.

The consult code itself is a problem visit. The only time I am aware of having 2 E/M services during the same visit is when one is preventive and the other is a problem. So you would just use the info regarding the anxiety and add that to the pre-op reasons and level it all together as a consult.

Of course there is also the scenario of workers comp visits in addition to private insurance visit but I don't think that is your situation in this case.

Just my opinion,

Laura, CPC, CEMC


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