Pediatric Coding Alert
Preoperative Exam
Connecticut Subscriber
Answer: Some coders use the sick-visit codes (99212-99215), but the consultation codes (99241-99245) may pay better, depending on which level of service is appropriate. The consultation codes are suitable because you are doing the exam at the request of another physician the surgeon. And because the exam would be detailed you need to look at many systems the appropriate consultation code would often be 99243 or even 99244.
It would depend on the level of decision-making, which would usually be low, since all you need to do is determine if the child is healthy for surgery. Remember, there are three conditions for billing a consultation: (1) a request from the provider for your opinion or advice; (2) seeing the patient, and (3) a return letter to the requesting provider.
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