Primary Care Coding Alert

Question: Our doctor does preoperative testing on patients. Usually the pre-op includes an E/M and an electrocardiogram (ECG). Can we charge for this service? If so, how should we bill it? 

Wisconsin Subscriber

 
Answer: Yes, you can bill for preoperative testing performed by the FP. Use the consultation codes (99241-99245) for the patient evaluation, if the preoperative testing was done at the request of the physician performing surgery. The surgeon is essentially seeking the FPs opinion on whether the patient is fit for surgery. To bill the consultation codes, make sure the FP documents who requested the consultation and what, if any, tests or services were ordered or performed. The FP also needs to send a written report to the surgeon with his or her opinion. You can charge separately for the ECG with 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report). Link V72.81 (Special investigations and examinations; other specified examinations, preoperative cardiovascular examination) to the 93000 and V72.83 (Other specified preoperative examination) to the consultation code. Also, include a secondary diagnosis code indicating the reason for the surgery.
 
A third diagnosis code indicating any other condition that could affect the patient may also help establish medical necessity. For example, a patient about to undergo cataract surgery is sent to the FP because he has hypertension, which may affect the surgery. The ophthalmologist is seeking the opinion of the FP as to whether the patient will be able to have the cataract surgery. The FP performs an examination and ECG and determines that the patients hypertension will not affect surgery. The FP writes a note to the ophthalmologist with his or her opinion. Code the appropriate consultation code for this visit with 93000 and V72.8x. You may also want to include the code for the hypertension (401.x) and cataract (e.g., 366.9) as appropriate. Whether the FP has seen the patient before is irrelevant because the consult codes include new and established patients.
 
In some cases, the patients receiving pre-op ECGs may not have cardiac conditions. Many hospitals require all patients to have a physical and ECG taken before surgery. When the patient does not have a cardiac condition that may affect surgery, you can only use the V code and the diagnosis code for the reason the patient is having the procedure. Practices may face denials for this type of testing because many payers do not recognize V codes. In addition, the diagnosis code for the reason for the surgery may not establish medical necessity for the ECG. If the patient in the previous example did not have hypertension, the cataract code may not justify the test and probably will not procure payment. Some carriers require that the V code be listed as secondary. Ask your carrier which method it prefers.