Internal Medicine Coding Alert

Question: A patient came in for a preoperative visit three days before his surgery. Can we bill it as a nurse visit or is this just a preoperative visit that is not billed?

Utah Subscriber

Answer: Medicare established a uniform definition for the global surgery package in 1992 in an effort to ensure consistency among carriers. As part of that process, the following are a few of the services considered part of the global package:

1. Preoperative visits: Include preoperative visits after the decision for surgery has been made, beginning with the day before surgery for major procedures and the day of surgery for minor procedures [MCM 4820].

2. Intraoperative procedures: Include services that are a normal and necessary part of the procedure itself.

3. Postoperative visits: Include 90 days postoperative for major procedures and 0 or 10 days for minor surgical procedures or endoscopies.

Your doctor followed Medicare guidelines when he or she billed for a visit three days preoperatively. That, of course, assumes that this is a Medicare patient. Not every third-party payer follows Medicares definition of the global surgery package. If this is not a Medicare patient, you need to ask the carrier to verify its definition of preoperative care.