Ob-Gyn Coding Alert

Question: In the July 2002 issue, you state that the pre-op visit is included in the surgery global package and that billing separately for it is fraudulent. In the January 2002 issue, however, the cover article states that the "CPT guidelines indicate that the E/M visit that occurs more than a day before surgery (and after the decision for surgery) can be billed outside of the global surgical package." We had been advised that starting in 2002, the preoperative visit could no longer be billed separately. Would you please clarify the situation?

Connecticut Subscriber

Answer: Both articles deal with the issue of the preoperative visit. The January article presented the new CPT interpretation of the pre-op visit that any visit prior to the day before surgery could be billed but that private payers might not agree, so you should ask payers if they consider a pre-op visit included or excluded from the global package.

The July 2002 article clarified that you would probably have to follow more than one set of rules when reporting a preoperative exam. Specifically, the article stated that Medicare did not allow you to bill the pre-op visit, but that some payers may allow it if not within a day of the surgery (as outlined in the CPT guidelines). A payer who defines the pre-op visit as included would consider billing for it separately as fraudulent. "Private payers do not necessarily follow Medicare rules, so you should verify that the insurance companies you deal with include a pre-op visit in their global packages. If so, billing an E/M service for the pre-op visit could be considered fraudulent," the July article stated. We did not intend to imply by that answer that it is fraudulent to bill any pre-op visit.