Gastroenterology Coding Alert

You Be the Coder:

Preoperative Clearance Exams Are Risky

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: How can I receive reimbursement from Medicare for a preoperative clearance visit when the patient is at high risk (e.g., for cardiac or respiratory diagnoses)? I have heard that I can bill a consultation or initial visit to Medicare if I bill first with the preoperative cardiac code (V72.81) and second with V76.51 (Special screening for malignant neoplasms; colon). Tennessee Subscriber

Answer: You may find it difficult to receive proper reimbursement for a preoperative clearance consultation because carriers have different interpretations of how to code for the service. Denials are common even when you use the appropriate V codes. You should use the appropriate preoperative V code rather than the condition that warrants the surgery to justify the examination. However, medical necessity for such preoperative clearance remains at the discretion of the local Medicare carrier.

You must use one of the four appropriate preoperative examination ICD-9 codes when billing for a preoperative consultation:
V72.81 Pre-op cardiovascular exam
V72.82 Pre-op respiratory exam
V72.83 Other specified pre-op exam
V72.84 Pre-op exam, unspecified. Medicare carriers will pay for or deny a preoperative clearance based on the medical diagnosis and the careful choice of a secondary diagnosis to indicate the reason for the surgery. Unless the physician sees a patient for a specific problem, the first diagnosis should be the preoperative V code. The second diagnosis is the reason for the surgery. The third and fourth diagnoses indicate any complications that may be present.

Depending on the situation, you should report a new patient code (99201-99205) or established patient code (99212-99215) when the physician performs the examination in an office or outpatient setting.  
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Which Codify by AAPC tool is right for you?

Call 844-334-2816 to speak with a Codify by AAPC specialist now.