Wiki pre-op exam -few doctors in our practice

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spebuck

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We have a few doctors in our practice who insist that if they perform a pre-op exam more than 48 hours before a scheduled surgery that it should be paid as a regular E&M.
My understanding is that if the visit is scheduled as a pre-op & is dictated as a pre-op exam, then it's a pre-op exam and is subject to global in that it would be considered part of the surgery-regardless of the time that the exam was done (unless the pt had a different complaint or the surgery was postponed).
Is there a specific guideline that I can show them?
Or am I missing something in my understanding of how this works?
 
spebuck said:
We have a few doctors in our practice who insist that if they perform a pre-op exam more than 48 hours before a scheduled surgery that it should be paid as a regular E&M.
My understanding is that if the visit is scheduled as a pre-op & is dictated as a pre-op exam, then it's a pre-op exam and is subject to global in that it would be considered part of the surgery-regardless of the time that the exam was done (unless the pt had a different complaint or the surgery was postponed).
Is there a specific guideline that I can show them?
Or am I missing something in my understanding of how this works?
Click to expand...

It all comes down to documentation. There's a very good CPT Assistant article on pre-op exams and how the date of exam doesn't really come in to play.
 
Look at the CPT Surgical package Definition in the Surgery Guidelines. Second bullet point:

"Subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of procedure (including history and physicial)."

I would agree with your physicians on this point. It sounds like the E/M encounter you are talking about in the global package would be when the surgeon visits the patient just before surgery.

nyyankees - which CPT Assistant article? When I ran a search for pre-op, I got an anrticle that it is not part of preventative services.
 
MnTwins29 said:
Look at the CPT Surgical package Definition in the Surgery Guidelines. Second bullet point:

"Subsequent to the decision for surgery, one related E/M encounter on the date immediately prior to or on the date of procedure (including history and physicial)."

I would agree with your physicians on this point. It sounds like the E/M encounter you are talking about in the global package would be when the surgeon visits the patient just before surgery.

nyyankees - which CPT Assistant article? When I ran a search for pre-op, I got an anrticle that it is not part of preventative services.
Click to expand...

CPT Assistant May 2009 revisits this scenario.
 
You would have to prove medical necessity for these visits. I find it interesting that they're scheduled 48 hours prior to surgery and not the day before (and so will CMS). Regardless of the "24 hour" rule for global surgery (nnyankess is correct), you are setting yourselves up for an audit if this becomes the norm.
 
Pre-OP

My docs would also like to know if they are educating and couseling the patient about the surgery aside from the H&P, using time, would they be able to bill this?
 
Per-op exams

In these cases, the decision for surgery has been made, questions answered,the surgery has been scheduled, & the pt is coming in only for a pre-op H&P.
I'll code it w/ V72.83 as well as the dx for the surgery, but am still feeling uncomfortable with the scenario.
 
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