Pulmonology Coding Alert

Question: What is the correct method to bill a presurgical physical (99243, office consultation) so we can get paid for the office visit as well as the tests performed? We are having trouble getting some insurers to pay when we bill with diagnosis ICD-9 V72.82 (preoperative respiratory examination).

Ohio Subscriber


Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.




Answer: If the preoperative service you are providing is clearance for surgery for another physician (for example, performing a physical for one of your emphysema patients before an angioplasty that a cardiac surgeon will be performing), you should list V72.82 (preoperative respiratory examination) as the first diagnosis. You should also list a second diagnosis, which represents the medical reason requiring the clearance (i.e., 492.8, emphysema). The carrier may not pay for all the tests for all the patients unless there is an underlying reason for performing the pulmonary or lab test, not simply that we order these for all patients having surgery.

You should always have the patient sign a waiver (even patients who do not rely on Medicare) to inform them that the cost of these services may be their responsibility. Be prepared to receive denials for those cases where the patient does have a specific underlying condition that requires special testing.

CPT states that the actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the levels of evaluation and management services. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the E/M code. Be sure to add modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code in cases where the tests being performed carry 0-10 day global periods. Failing to apply the modifier could result in payment for the tests and not the evaluation and management service provided.