Wiki Pre-Op History and Physical

Create Wiki
C

CMMORSE

New
Messages
7
Best answers
0
Is it normal for a pre-op history and physical to be scheduled for two weeks prior to an arthroscopic surgery and be billed as a separate e/m visit? Here is the scenario that we are dealing with:
Decision for surgery is made during an office visit and the surgery is scheduled the following month and a level four or five office visit is billed.
A pre-op history and physical performed by the surgeon takes place at the location of the surgery approximately two weeks prior to the surgery and the insurance company is billed for a level five office visit.
I know that the guidelines state pre-op care should be included in the global surgical package for the day before or day of surgery, but is the surgeon circumventing the surgical package by scheduling the pre-op visit so far in advance? I appreciate any help I can get with this!
 
Circumventing the rules

The surgeon is trying to circumvent the rules and is commiting fraud. The pre-operative H&P is ALREADY being PAID as part of the reimbursement for the surgery. Scheduling it a week or more in advance to get around this rule is out and out wrong. I have no problem with the visit being scheduled in advance to ensure there aren't any issues that would preclude going forward with surgery. But you should not be charging for this visit. It is global to the surgery.

F Tessa Bartels, CPC, CEMC
 
I agree 100%. Unless a totally separate problem is discussed, this visit would be included with the surgery. The provider was already paid for the E/M when the decision for surgery was made.
 
If the HP clearance is provided by primary care physician, different taxonomy one to two days of surgery. This should be included in surgical package as well? I have been unclear about this since the surgeon is attached to both the multiple specialty group and the ASC.
 
48000lynn said:
If the HP clearance is provided by primary care physician, different taxonomy one to two days of surgery. This should be included in surgical package as well? I have been unclear about this since the surgeon is attached to both the multiple specialty group and the ASC.
Click to expand...
The surgeon should be performing the pre-op physical unless there is specific circumstances where another specialist may need to be involved, but that is rare. Since it's being performed by a provider that the surgeon is associated with, this should not be billed. I have seen doctors be creative in an attempt to get pre-op visits paid, I hope this is not one of them. Red flag alert.
 
By "HP clearance" do you mean a medical clearance by the PCP to determine if the patient is healthy enough to undergo the procedure? If so, at least in my area, I have never seen any do medical clearance on their patient. Sometimes they determine clearance isn't required like for a young, healthy patient undergoing a minor procedure.
The surgeon will order PST labs and testing. The patient will then go to their PCP to evaluate the testing, hypertension, diabetes, COPD, etc and determine if the patient is cleared to have the surgery. Sometimes even an additional specialist will also have to provide clearance (cardio, endo, pulm) if the patient has an extensive underlying condition not managed by the PCP.
That medical clearance visit by the PCP (or other specialist) is not part of the global surgical package. It is a distinct service being provided by a different type of physician.

If by "HP clearance", you mean the H&P before the surgery by the surgeon (review surgery, risks, recovery, etc.) then that is definitely included as part of the global surgical package.
 
You must log in or register to reply here.
Top