# AnesthesiologiIst performing H&Ps



## consultingbykristin (May 5, 2014)

Hi all,

I have an anesthesiologist who wants to perform pre-operative H&Ps in a hospital clinic.  He will have NO involvement in the anesthesia services and will be performing the H&P only.

Questions--can/should this be done?  It is unbundling services (to an extent) so I want to  be sure of coding and modifiers and that he will be reimbursed.

I'm thinking of modifier 24, CPT codes 99201-99205.

Is anyone else providing this service?  Are you getting paid?  Any information or sources you can provide would also be helpful.

Thanks in advance.


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## Michele Hannon (May 5, 2014)

Preoperative assessment is included in the payment for the anesthesia services, per the National Correct Coding Initiative (NCCI) Manual, Chapter 2. http://www.cms.hhs.gov/NationalCorrectCodInitEd/

From that manual:

HCPCS/CPT? codes include all services usually performed as part of the procedure as a standard of medical/surgical practice.  A physician should not separately report these services simply because HCPCS/CPT? codes exist for them.

The anesthesia care package consists of preoperative evaluation, standard preparation and monitoring services, administration of anesthesia, and post- anesthesia recovery care.

Preoperative evaluation includes a sufficient history and physical examination so that the risk of adverse reactions can be minimized, alternative approaches to anesthesia planned, and all questions answered.

Anesthesia services include, but are not limited to, preoperative evaluation of the patient, administration of anesthetic, other medications, blood, and fluids, monitoring of physiological parameters, and other supportive services.

3. It is standard medical practice for an anesthesia practitioner to perform a patient examination and evaluation prior to surgery.  This is considered part of the anesthesia service and is included in the base unit of the anesthesia code.

The evaluation and examination are not reported in the anesthesia time.  If surgery is canceled, subsequent to the preoperative evaluation, payment may be allowed to the anesthesiologist for an evaluation and management service and the appropriate E&M code (usually a consultation code) may be reported.  (A non-medically directed CRNA may also report an E&M code under these circumstances if permitted by state law.)

CPT? codes describing services that are integral to an anesthesia service include but are not limited to, the following:

•  99201-99499 (Evaluation and management)



The CPT? book, in its Anesthesia Guidelines, at the start of the Anesthesia section, states, “These services include the usual preoperative and postoperative visits….”


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## consultingbykristin (May 7, 2014)

Thanks Michelle for the reply.  This anesthesiologist will have nothing to do with the actual anesthesia services.  Realizing it's bundled, my quest is to find out if others are seeing similar situations and are able to successfully get paid.

The patient must have an H&P by a provider prior to surgery, typically, the surgeon or PCP performs that service.  This is being done by an anesthesiologist who also happens to be an internal medicine specialist.  And again--he is NOT doing any anesthesia services.


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## LeslieJ (May 15, 2014)

Doesn't matter if the anesthesiologist is doing anesthesia services or just providing the H&P. CMS recognizes the fact that there are times when the MDA who is doing the H&P isn't the same one as the MDA who is providing the anesthesia services.

It's bundled.

The question to ask is this: what's the medical necessity for the H&P?  If it's for the anesthesia services, then it's not billable; it's part of anesthesia services, regardless of the fact that another person is doing it.

I don't see anything in your post to indicate that there's any other reason for why an H&P would be different than the routine H&P services that are described quite well by Ms. Hannon in her post.

If the patient is having a pre-op exam as required by the hospital prior to surgery, and the surgeon isn't an MD (such as some podiatrists), it may be possible to bill it out separately.  However, the documentation should show good medical necessity for it and should show work that's above & beyond the routine.

See my post that answers this with links from ASA & Codapedia under OB Consults here
https://www.aapc.com/memberarea/forums/showthread.php?t=108440

Like I mentioned to Lulubelle - be very careful - the question is this: what's the medical necessity? and the answer should be well documented.


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## laniwho (Jul 28, 2022)

consultingbykristin said:


> Thanks Michelle for the reply.  This anesthesiologist will have nothing to do with the actual anesthesia services.  Realizing it's bundled, my quest is to find out if others are seeing similar situations and are able to successfully get paid.
> 
> The patient must have an H&P by a provider prior to surgery, typically, the surgeon or PCP performs that service.  This is being done by an anesthesiologist who also happens to be an internal medicine specialist.  And again--he is NOT doing any anesthesia services.


Hi Kristin - wondering if you ever received any input from payers on this.  I have been approached by an anesthesiologist with some what the same question. He is thinking of opening a practice for Pre-Op exams only.
 He is an MD but not a PCP.


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## LisaAlonso23 (Jul 29, 2022)

To piggyback on the above responses...

Please know that, if the patient received anesthesia services by another provider, the H&P performed by your provider is bundled regardless. It's part of the anesthesia service and cannot be billed separately.

I once had anesthesiologists try to have me bill H&Ps separately when they provided anesthesia services for Podiatry patients citing that the H&P was more detailed, due to the Podiatrist not being an MD.  H&P exams are bundled regardless of surgeon type.


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