Internal Medicine Coding Alert

Question: How do I code for a presurgical physical (99244) so insurance carriers will pay for the office visit as well as the labs performed? Our office is having trouble getting paid when we bill with diagnosis code V72.84 (preoperative examination, unspecified).

Ohio Subscriber

Answer: This is an ongoing challenge for coders and practices providing this sort of physical. First, you must code only for the service rendered. And, unfortunately, that may mean that many carriers will disallow general preoperative lab services.

If the preoperative service your office provides is surgery clearance for another physician, then coders should list the second diagnosis (i.e., 746.5, congenital mitral stenosis) as the medical reason requiring the clearance. Code V72.81 is for preoperative cardiovascular exam and should be listed as the first code. Use this code if the patient has a cardiac condition. In addition, use code V72.82 (preoperative respiratory exam) if the patient has a respiratory condition such as chronic obstructive pulmonary disease (COPD, 496). Even then, some insurance carriers will still consider it screening but it more accurately reflects the need for the preoperative exam than the unspecified preoperative exam code (V72.84). Nevertheless, the carrier may not pay for all the labs for all patients unless there is an underlying reason for performing the lab service. Simply saying, We order these for all patients having surgery, is not reason enough.

In any event, make certain that patients sign a waiver beforehand so they clearly know that the cost of these services may be their responsibility. Also, be prepared to appeal cases where the patient does have a specific underlying condition that requires special testing (i.e., 493.90, asthma, unspecified, without mention of status asthmaticus). CPT states the performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the levels of E/M services. However, those diagnostic tests/studies that are conducted by the physician for which specific CPT codes are available may be reported separately in addition to the appropriate E/M code.