Primary Care Coding Alert

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?

South Carolina Subscriber 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.

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.