EM Coding Alert

Question: A Medicare patient came in to see our pulmonologist to get clearance for her knee replacement surgery upon the request of her orthopedic surgeon. The orthopedic surgeon wants to make sure her lungs are strong enough to handle the procedure and the post-procedure recovery. How do I code this?

Massachusetts Subscriber

Answer: Depending on the details of the encounter and the payer’s requirements, you would most likely choose the most appropriate E/M office visit code from the 99201-99214 (Office or other outpatient visit …) range for this pre-operative clearance encounter. 

Reminder: You may also want to look at the consultation codes (99241-99245, Office consultation for a new or established patient, …) for payers not following Medicare guidelines if the documentation meets the criteria for consultation coding.

You would include a primary diagnosis of V72.83 (Other specified preoperative examination) along with the diagnosis of the condition requiring surgery.

The pulmonologist might, for example, include both COPD (for instance, 491.21, Obstructive chronic bronchitis with [acute] exacerbation) and knee arthritis (such as 715.16, Osteoarthrosis localized primary involving lower leg) as secondary diagnoses to V72.83. He should also include diagnoses for any other co-morbid conditions.

Pointer: You are able to code and bill for this pre-operative encounter because your physician is not the one performing the surgical procedure. The surgeon performing the surgery would not be able to report a pre-op exam because you should not bill a pre-operative clearance that is administrative as it is not a chargeable service and not payable. If you are performing a pre-op exam for another surgeon, as in your case, however, the visit is payable.