Primary Care Coding Alert

Question: Ophthalmologists always request our opinion on whether patients scheduled for cataract surgery can undergo surgery. How do we get Medicare to cover these preoperative consultations? Michigan Subscriber Answer: Technically, the surgery's global package includes the preoperative exam performed by the operating physician. Medicare, however, will cover preoperative consultation (99241-99245, Office consultation for a new or established patient, which requires these three key components-) for patients for whom the Medicare carrier or Medicare administrative contractor (MAC) considers it medically necessary (such as patients who have a comorbidity that may complicate the surgery). Check with your Medicare carrier or MAC to see if it has a local coverage determination on this matter. Preoperative consultations are generally payable for new or established patients performed by any physician or qualified nonphysician practitioner at the request of a surgeon, provided all the consultation code requirements are met and the service is medically necessary and [...]