Question: To cover preoperative consultations, Medicare requires V72.81-V72.84 for the primary diagnosis. If my family physician performs a consultation, ECG, and orders lab tests, should I use the same diagnosis (within the range) for all of her services? Also, may she report V72.81 and V72.82, or are these codes reserved for specialists? Answer: For the consultation and the diagnostic tests, you should use V72.81-V72.84 based on exam type, not the physician's specialty. Medicare also requires you to list in the secondary position the reason that prompted the surgery.
South Carolina Subscriber
For instance, an ophthalmologist requests a preoperative clearance from your FP for a hypertensive 70-year-old man who will have cataract surgery. Your physician performs an E/M service and orders an electrocardiogram (ECG) and a blood draw for various lab tests. After reviewing the diagnostic test results, the FP issues a report to the ophthalmologist clearing the patient for surgery.
To bill Medicare for this consultation, you should report V72.83 (Other specified preoperative examination) for the consultation (99241-99245, Office consultation for a new or established patient), V72.81 (Preoperative cardiovascular examination) for the ECG (93000, Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), and V72.83 for the blood draw (G0001, Routine venipuncture for collection of specimen[s]). Use the reason for the surgery - the cataract, such as 366.13 (Anterior subcapsular polar senile cataract) - as the secondary diagnosis. You should assign a diagnosis for the patient's hypertension (for instance, 401.1, Essential hypertension; benign).
Make sure to list the surgeon (with his unique personal identification number) as the referring physician on the claim.