Primary Care Coding Alert

Question: How should we code for surgical clearance of an established Medicaid patient?

Answer: If your Medicaid carrier still pays for consult codes, choose the most appropriate code from 99241-99245 (Office consultation for a new or established patient ...). If Medicaid no longer accepts consult codes, select an E/M code for the visit (99212- 99215, Office or other outpatient visit for the evaluation and management of an established patient ...).

Support: Include the appropriate V code for the preoperative exam (V72.81-V72.84). You can list these codes as either primary or secondary diagnoses, so check your carrier's guidelines. Also include the diagnosis prompting surgery, whether as your primary or secondary diagnosis.