Pulmonology Coding Alert

Question: One of my doctors recently heard that we should use a consultation code, such as 99241, when doing a preoperative history and physical.

Weve always billed a new or established patient level, such as 99201, which is just the same as 99241, except that the first paragraph reads office or other outpatient visit for the evaluation and management of a new patient.

Which is right?

Texas Subscriber

Answer: When a physician provides a preoperative consultation at the request of a surgeon, that meets the criteria for a consultation: (1) a request for an opinion or advice, (2) a specific reason that the opinion is needed, and (3) a written report of the findings. If all these criteria are met, you may use a consultation code.

Usually the patients underlying medical condition, such as chronic obstructive pulmonary disease (COPD), might cause concern or problems during the surgery or immediately afterwards. Your physician will be providing an opinion about the patients ability to undergo the procedure based on these conditions, as well as recommending a treatment plan to manage the potential problems. Your diagnosis code should be V72.82 (pre-operative respiratory examination) and the diagnosis code for the underlying medical condition.

Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant and educator in North Augusta, S.C.