Practice Management Alert

Question: One of our physicians performed a follow-up test in-office to make sure that a procedure was successful. I am pretty sure that this recheck is part of the initial procedure and that we cannot bill for the visit, but my colleague thinks otherwise. Who’s right?

Codify Subscriber

Answer: If the test is a routine part of the follow-up on a procedure, you cannot bill for it.

“Diagnostic tests performed strictly and routinely to confirm the success of a surgical procedure are considered to be a component of a surgical procedure and not separately billable,” says Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at CodeCast, in Laguna Niguel,  California.

Similarly, you cannot bill for an office visit having to do with an elective procedure on the same day as the elective procedure, she says.

“The Medicare Claims Processing Manual is so clear about this. It specifies that a preoperative visit provided after the decision for surgery was made — those are included in the surgical reimbursement and not separately billable,” she says.

Providers “should not report any E/M service on the day of or the day before the device surgery or any surgery. Physicians should not report any visits on the day something is planned or scheduled unless it’s completely for a different reason,” Fletcher says.