Part B Insider (Multispecialty) Coding Alert

Z01.818 will be your friend under ICD-10 when you perform preop visits.

If a surgeon performs a preoperative visit with a patient the day before he does surgery on her, that visit is included in the surgical global fee. But if the surgeon sends the patient to a different physician for surgical clearance, that physician’s coding options have typically been limited to E/M codes linked to V codes for diagnoses. However, that option will change drastically under ICD-10 next year, forcing you to move to Z codes for these visits.

Example: Suppose a Medicare patient with COPD visits your pulmonologist to gain clearance for knee replacement surgery. The orthopedic surgeon wants confirmation that the patient’s lungs are strong enough to handle the procedure and the post-procedure recovery.

Solution: The pulmonologist will typically choose the most appropriate E/M office visit code from 99201-99214, depending on the specifics of the encounter and the payer. Link V72.83 (Other specified preoperative exam) as the primary diagnosis along with the diagnosis of the condition requiring surgery.

The pulmonologist in our example might report 99213 for the visit, and include both COPD (for instance, 491.21) and knee arthritis (such as 715.16) as secondary diagnoses to V72.83. He should also include diagnoses for any other co-morbid conditions.

Tip: Ask your physicians to include a statement at the beginning of dictation about the surgical clearance. They might state, “Patient is here to get clearance for knee replacement surgery due to _________ (chronic conditions).”

Right now your surgical clearance codes are limited to the following:

• V72.81—Preoperative cardiovascular examination
• V72.82—Preoperative respiratory examination
• V72.83—Other specified preoperative examination
• V72.84—Preoperative examination unspecified

Under ICD-10, however, you’ll report from the following list:

• Z01.810—Encounter for preprocedural cardiovascular examination
• Z01.811—Encounter for preprocedural respiratory examination
• Z01.818—Encounter for other preprocedural examination
• Z01.812—Encounter for preprocedural laboratory examination

Remember to change over your superbills and the codes within your system prior to Oct. 1, 2014 to ensure that you’re reporting ‘Z’ codes at that point rather than ‘V’ codes.