Pulmonology Coding Alert

If you fear a denial every time you choose an ICD-9 code for a "normal" study, you're in luck with pre-op evaluations.

Rule: Medicare's guidelines for coding pre-op exams include:

1. Report the pre-op V code first. "The ICD-9 code that appears in the line item of a preoperative examination or diagnostic test must be the code for the appropriate preoperative examination (namely, V72.81 through V72.83)," according to CMS transmittal 1719, (www.cms.hhs.gov/transmittals/downloads/R1719B3.pdf). Most insurers treat with caution the unspecified pre-op exam code (V72.84).

2. Include the diagnosis that prompted surgery along with the condition that prompted the pre-op evaluation (for instance, the condition that increases the patient's surgical risk), if any.

3. Follow these with other diagnoses and conditions affecting the patient.

Benefit: The transmittal states that preoperative diagnostic tests are payable if they are medically necessary. Medicare looks to national coverage determinations (NCDs) first to establish necessity.

If there is no NCD, you can help prove the service is reasonable and necessary by including the ICD-9 codes for the conditions that prompt the surgery and the test, the transmittal states.