Practice Management Alert

Question: How do you bill for a pre-operative exam a primary care physician conducts? Should I use a V code for the diagnosis? If so, what should I use as a diagnosis for an EKG and chest x-ray?
  
California Subscriber

Answer: In June of 2001, CMS told Medicare carriers not to automatically deny pre-op exam claims submitted with V codes, says Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, NJ. That means you should bill a V code for the pre-op exam first, then code for the medical reason the PCP is seeing the patient, and then list the reason for the surgery, she instructs.
 
Consider the case of a patient who has congestive heart failure, Brink offers. If the surgeon wants a cardiology pre-op consult, the first thing you'd bill would be V72.81 (pre-operative cardiovascular examination). Next, you'd list the code for the patient's cardiovascular problem (congestive heart failure) and then the code for the reason the patient is having surgery (for example, total hip replacement), she counsels.
 
If you follow this sequence and find out your claim is being denied, try changing the order the codes are billed. Even though CMS has said payers should not deny V codes for pre-op consults, "some Medicare carriers and payers still deny when a V code is listed first (i.e., V72.81 pre-op cardiology consultation)," Brink notes. If you are in this situation, list the medical reason for consult first, then the reason for surgery and then the pre-op V code, she suggests. Even though it's technically more appropriate to list the V code first, many practices find that if they follow this sequence, they get paid right away and don't have to go through the appeals process.
 
Regarding how you'd bill for the EKG and chest x-ray: that will depend on why the primary care physician is ordering the test, since the EKG and chest x-ray are usually part of a patient's pre-admission testing, Brink cautions. "If the primary care physician is seeing the patient for pre-op consult for congestive heart failure and needs the chest x-ray and EKG in order to give his opinion that the patient can undergo surgery, then they should be billable," she says. The ICD-9 codes for the EKG and chest x-ray would be the medical reason that warranted the physician ordering them.