Wiki Pre-op for 'mini facelift'

[cmercado0526]

Good morning! One of my providers did a pre-op eval on a Medicare patient having a mini facelift. The doc had the patient scheduled as a follow up visit - chronic issues, only the doc and patient knew the real reason. I'm thinking Medicare isn't going to cover this E/M visit. Of course no ABN was signed since the front office staff didn't know the real reason for the visit either. This is not billable to the patient, is it? The provider says the patient would probably pay for it, but I believe that is 'against the rules.' What does anyone else think?
Thanks

 

[mitchellde]

This all comes down to what was documented in the chart note. One person can say this one can say that and so on but what is in the chart note speaks to what is billed. If this was indeed a pre op visit for a scheduled surgery elective cosmetic or therapeutic then it is inclusive to the procedure and not a billable service. If this was the visit to evaluate the patient for the need for surgery then it is billabloe and if the surgery in question is elective cosmetic then the visit is billed to the patient. There is a dx code for elective cosmetic.

 

[cmercado0526]

We are the PCP office, in no way associated with the surgeon's office or whether or not she needed it. The patient was just being seen to be medically cleared, healthy enough, to have surgery.

 

[mitchellde]

if it is documented as a medical clearance for a planned surgery then you can bill the surgical code with the 56 modifier to indicate you are providing the preop portion of the surgery. However the patient's plastic surgeon may have a difficulty with splitting off 15% of the surgical cost to you. Therefore as this is elective cosmetic then yes perhaps an OV is the way to go and yes bill the patient if it is documented as a preop encounter. You do not need an ABN on this one as it is a non covered service. You can bill to Medicare and append the GX modifier and they will instruct the patient to pay you.