Ob-Gyn Coding Alert

Question: When can I bill a consultation for a preoperative clearance?

Wyoming Subscriber
 
Answer: Your ob-gyn can perform preoperative consultations for a new or established patient at a surgeon's request as long as all of the requirements for the consult codes are met and medical necessity is documented.
 
One of the problems with preoperative visits is that the surgeon doesn't make a direct request for a consultation. The patient arrives with a form and says, "Please fill this out before I have my knee surgery done next week." That is not a request for an opinion. The physician or the nurse practitioner or the physician assistant usually fills out the form with the appropriate history and examination and sends it not to the operating physician or to the surgeon, but to the hospital or surgery center.
 
Another problem with these visits is that the form usually has very little room for the history of present illness (HPI). If there is little or no HPI - for example, "She is here because her hip has been bothering her" - those notes audit down to the lowest level, even when the consultation request has been documented and the service performed and the note sent back to the requesting physician. Take a look at those forms, and if they are not giving your ob-gyn room to write the HPI, you should either have the ob-gyn dictate a note or have the hospital or surgery center amend the forms.