Podiatry Coding & Billing Alert

Billing a pre-op H&P for established patients is not an option.

Not everyone agrees on when -- if ever -- separately reporting a pre-op history and physical (H&P) is allowable. According to one school of thought, pre-op encounters that take place outside of the global period (more than one full day in advance of the surgery date for major procedures) are not technically included in the global package.

Whether to report an E/M for a pre-op visit ultimately depends on the circumstances, comments Renee Hilgert, owner and manager of Dallas-based Podiatry Claims consulting service in, but an E/M code may be allowed for pre-op visits.

Others tend to stick with the conventional coding mores. "If the visit is for the pre-operative clearance for the procedure, it is not billable no matter when it is performed," says Becky Zellmer, CPC, MBS, CBCS, operations supervisor for Madison, Wis.- based SVA Healthcare Services, echoing the conventional way of billing. "The payment for the preoperative work is included in the surgical code."

How to decide: The difference may lie in whether the patient in question is an established one. "If the patient has been a long standing patient of a practice and decides to have foot surgery, then the pre-operative H&P is already paid for as part of the reimbursement for the surgery," stresses Richard Odom, DPM, ABPS, CPC, a podiatrist in Spanish Fort, Ala.

"Essentially, it is fraudulent to bill for a pre-op H&P when the patient is known to the practice."

The loophole may be the DPM is performing a pre-op service for a new patient more than 24 hours before a major procedure, which another DPM is performing. In this instance, you may consider reporting a new patient E/M (99201-99205) instead of appending modifier 56 (Preoperative management only) to the CPT surgical code.

Bottom line: To stay compliant and avoid fraudulent billing, you must check your local Medicare Administrative Contractor (MAC) or private payer guidelines.