Wiki Pre-op question when billed by surgeon

[Jenny Easter]

I have been searching for some documentation and was hoping that one of you could steer me in the right direction...
I have a surgeon who saw a patient and made a decision for surgery. He performed a comprehensive history and exam. Two weeks later he saw the patient for a pre-op exam, EPF history but the exam was basically the same one he performed initially. He stated that the patient agrees to surgery (even though they already had previously as stated in the previous note) and the patient is billed 99211 for this visit.
My issues with this:
1) Can a surgeon perform their own pre-op?
2) The documentation meets the requirements for 99214, not 99211.
3) Why would the provider need to see the patient back this soon if surgery is scheduled for the following week, and why would they need to do such an extensive exam? On this same note, why would you bill such a low level office visit code for doing such an extensive exam?
Any guidance is welcomed!

 

[FTessaBartels]

Not Billable

From what you present, there is no medical necessity for this visit ... it is an administrative convenience for the surgeon to complete the hospital's required admission note before the actual date of surgery. The surgeon is mistaken in thinking that if s/he performs this service more than 24 hours prior to surgery date s/he can charge for the service.

No so.

The decision for surgery was made earlier.

The reimbursement for the surgery ALREADY INCLUDES payment for a pre-operative exam, so this visit should not be billed separately.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[Jenny Easter]

Thanks, it sure does!
My manager also found an article referencing the CPT Assistant in May 2009 that states "If the surgeon sees a patient and makes a decision for surgery and then the patient returns for a visit where the intent of the visit is the preoperative H&P, and this service occurs in the interval between the decision-making visit and the day of surgery, regardless of when the visit occurs (1 day, 3 days, or 2 weeks), the visit is not separately billable as it is included in the surgical package."
Thanks again!