# Pre op clearance for Medicare patients-We are seeing



## mhulwick

We are seeing a patient to clear them for surgery at the request of the surgeons.   Medicare no longer recognizes 99241-99245.  What is the appropriate way for the physician to document visit and code service provided.  
An EKG and Labs are usually always included. And sometimes cardiac referrals to ensure safety of anesthesia.
Help!


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## Belinda Frisch

*?*

According to the current CMS Carrier's Manual, preoperative consultations ARE payable. 

G. Consultation for Preoperative Clearance

Preoperative consultations are payable for new or established patients performed by any physician or qualified NPP at the request of a surgeon, as long as all of the requirements for performing and reporting the consultation codes are met and the service is medically necessary and not routine screening.
http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Here are other articles saying the same thing:

http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/1135.htm

http://hospitalmedicineadvisors.blogspot.com/2006/06/billing-for-consultations-new-guidance.html

http://www.aafp.org/fpm/20010900/16medi.html


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## RebeccaWoodward*

As Belinda thoroughly pointed out, these are payable.

G. Consultation for Preoperative Clearance
Preoperative consultations are payable for new or established patients performed by any physician or qualified NPP at the request of a surgeon, as long as all of the requirements for performing and reporting the consultation codes are met and the service is medically necessary and not routine screening.


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## TaraDyess

rebeccawoodward said:


> As Belinda thoroughly pointed out, these are payable.
> 
> G. Consultation for Preoperative Clearance
> Preoperative consultations are payable for new or established patients performed by any physician or qualified NPP at the request of a surgeon, as long as all of the requirements for performing and reporting the consultation codes are met and the service is medically necessary and not routine screening.


Okay so if medicare is now excepting these eval codes why do they not except certain diagnosis when coding EKG? Some pts have to have an EKG for preop but not every pt has diagnosis that cover for EKG. Not all pt have for example hypertension, or other cardiac problems to use for EKG so can you help on this subject. PLEASE my doctors get aggravated when I ask them to give me a dx to cover for this.

Thanks 
Tara CPC-A


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## RebeccaWoodward*

Are you using a "V" code for the pre-op exam?

Billing for pre-operative tests:
We are doing more and more preoperative visits, often several days prior to the actual surgery. If I order an EKG and read it, can I bill 93000 or is it bundled into the surgery?

Medicare will pay for preoperative tests that are reasonable and necessary. Each carrier maintains a list of ICD-9 codes that represent reasonably necessary reasons for diagnostic tests. Routine screening preoperative tests are not covered. When billing, in addition to the reason for performing the test, the physician should include the appropriate ICD-9 code from the V72.81-V72.84 series (pre-op testing). Medicare will only pay for one medically necessary preoperative test, so you need to be sure another physician (i.e., the surgeon, the primary-care physician providing pre-op clearance, etc.) has not already performed and billed for the test.

Consult clarification
As a primary-care physician, can I submit an office consult on one of my own patients when I have been sent a consult request from a surgeon for a pre-op clearance?  

Yes, Medicare officially stated several years ago that a physician could report a consultation code for a preoperative clearance if all the requirements of a consult are met — that is, the consult was requested by another provider and a written report is supplied to the referring physician. The consultation code can be reported even for an encounter with an established patient.

http://www.physicianspractice.com/index/fuseaction/articles.details/articleID/367.htm


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