Ob-Gyn Coding Alert

Question: Can we bill pre-op visits regardless of how many days away from surgery?

New Jersey Subscriber

Answer: The answer depends on the payer. If you bill, you MUST, under ICD-9 Guidelines, list V72.83 (Other specified pre-operative examination) as your primary diagnosis to allow the payer to follow their rules with regard to paying or not. Your secondary diagnosis will be the reason for the surgery. Many payers will not reimburse routine pre-ops no matter when they take place, while others do not consider them part of the surgical package payment.

But you should know that the relative values for all surgical codes include preoperative work, which was described when each code was added to CPT®. For instance, the preoperative work included with 58150 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]) is: “A comprehensive history is obtained and a comprehensive examination is performed to determine the patient’s current medical status. Indications for the procedure and its appropriateness are reviewed. Informed consent is obtained. The physician admits the patient to the hospital, prepares the hospital records and chart in accordance with hospital policy, checks on the patient, and reviews records prior to the surgery. The physician scrubs for the procedure and waits for anesthesia induction and the preparation of the patient.”

ICD-10: When your diagnosis system changes, you should report Z01.818 (Encounter for other preprocedural examination) instead.