Wiki Pre-op physical and condition dx sequencing

[karlam]

I work in a primary care/urgent care facility. We often perform pre-op clearance physicals. The issue I am having is that Tricare is not paying us for the physicals and is not holding the patient responsible either. We are coding the claim with the pre-op physical code V72.84 first and then the code for the reason for the surgery. I have people suggesting that the code for condition would be primary and then the pre-op physical code as secondary. I don't feel this is appropriate since we are not treating the condition, but performing the physical. Which way is appropriate? Thank you for any help!!

 

[Orthocoderpgu]

According to Deborah Grider who wrote the book "Principles of ICD9 Coding", you are correct. The V72.8X code is the primary DX. If you know what type of surgery they are having, why not use V72.83? It has a higher degree of specificity. What reason is Tricare giving for not paying?