Are you using a "V" code for the pre-op exam?
Billing for pre-operative tests:
We are doing more and more preoperative visits, often several days prior to the actual surgery. If I order an EKG and read it, can I bill 93000 or is it bundled into the surgery?
Medicare will pay for preoperative tests that are reasonable and necessary. Each carrier maintains a list of ICD-9 codes that represent reasonably necessary reasons for diagnostic tests. Routine screening preoperative tests are not covered. When billing, in addition to the reason for performing the test, the physician should include the appropriate ICD-9 code from the V72.81-V72.84 series (
pre-op testing). Medicare will only pay for one medically necessary preoperative test, so you need to be sure another physician (i.e., the surgeon, the primary-care physician providing pre-op clearance, etc.) has not already performed and billed for the test.
Consult clarification
As a primary-care physician, can I submit an office consult on one of my own patients when I have been sent a consult request from a surgeon for a pre-op clearance?
Yes, Medicare officially stated several years ago that a physician could report a consultation code for a preoperative clearance if all the requirements of a consult are met — that is, the consult was requested by another provider and a written report is supplied to the referring physician. The consultation code can be reported even for an encounter with an established patient.
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