Urology Coding Alert

Question: Our nurse practitioner does all the pre-op visits and pre-op examinations for our physicians. She dictates the H&P for the surgery from this visit. We do not bill for the H&P from the hospital standpoint, but we would like to use this record to bill for the in-office pre-op visit and examination our nurse practitioner performs. Can we use a hospital H&P and print a copy for our records and bill an in-office visit from that?

Missouri Subscriber

Answer: Unless the office visit is medically necessary to re-evaluate a condition, such as diabetes or hypertension, that may affect the proposed surgery, you should not bill for the visit that's strictly for obtaining preop information. Your pre-op history and physical (H&P) becomes an "administrative" H&P, especially if your urologist made the decision for surgery at another encounter and as such this H&P is not a billable service.

Reason: 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 performed by any physician or qualified nonphysician practitioner at the request of a surgeon are generally payable for new or established patients, provided all the consultation code requirements are met, and the service is medically necessary and not routine screening.

If you feel the visit is medically necessary, your primary or first diagnosis for the preoperative visit should be in the V72.8 (Other specified examinations) series, such as V72.84 (Pre-operative examination, unspecified). Your second diagnosis should be the reason for the present visit -- usually a medical problem that may complicate the upcoming surgical procedure. The third diagnosis you report should be the reason for the upcoming surgery, such as benign prostatic hyperplasia (BPH, 600.01, Hypertrophy [benign] of prostate with urinary obstruction and other lower urinary tract symptoms [LUTS]) or carcinoma of the prostate (185.0, Malignant neoplasm of prostate).