Wiki Pre Op Visit

[jeaner54175@yahoo.com]

Our provider had a patient come in for a pre op exam for foot surgery. She coded the visit as a preventive exam with a primary diagnosis of V72.84; also coded were blood work, EKG, and a chest xray. Throughout the documentation the providers dictates this is a physical for a pre-op exam, should this have been coded as a preventive exam or an E/M? The patient's insurance paid for the exam minus the lab, EKG, and xray and now she is upset because she needs her annual exam to have her prescriptions renewed and the insurance won't cover another exam. Any advise would be helpful.

Thank you,
Lisa Nieft

 

[mitchellde]

Our provider had a patient come in for a pre op exam for foot surgery. She coded the visit as a preventive exam with a primary diagnosis of V72.84; also coded were blood work, EKG, and a chest xray. Throughout the documentation the providers dictates this is a physical for a pre-op exam, should this have been coded as a preventive exam or an E/M? The patient's insurance paid for the exam minus the lab, EKG, and xray and now she is upset because she needs her annual exam to have her prescriptions renewed and the insurance won't cover another exam. Any advise would be helpful.

Thank you,
Lisa Nieft

It was incorrect to use a preventive CPT code for a pre op it should have been a visit level

 

[HOLLYGIFFIN]

The diagnosis code should have been V72.83 with the foot issue as a secondary diagnosis code with the office visit code charged (9921x), not a well woman code with preventive codes. This is not a preventive wellness exam, the patient obviously had a sign/symptom/problem issues requiring surgery and needed clearance. If the patient was sent by the foot surgeon for preop clearance by a primary doc, then the primary doc would actually bill out as a consultation code with the V72.83 dx (only if not Medicare) and would make sure the required documentation is there (written request, report of opinion, and report sent back to surgeon).

Either way, the patient did not present for a well woman exam, she presented for preoperative clearance for a problem which should be reflected accurately in the diagnosis code and E&M, which then would have corresponded to all the blood work/x-rays.

I would suggest you contact the insurance carrier and resubmit/refund/appeal, etc. to get the claim straightened out.

I hope this is helpful.
Holly Giffin, CPC, CPC-H
Physician Coding Auditor

 

[dclark7]

While I agree with the other two posters that this was coded incorrectly, my question is - If she recently had the physical why does she need another one just to have her meds renewed?

 

[MnTwins29]

While I agree with the other two posters that this was coded incorrectly, my question is - If she recently had the physical why does she need another one just to have her meds renewed?

The meds are being renewed - so an exam is probably needed to ensure they are working properly and no side effects, etc. You are probably thinking of REFILLS which wouldn't require the exam.

However, if this is for a renewal, why couldn't it be a F/U visit for the conditions requiring the medications instead of an annual exam? Then it would be coded to the condition and an established OV.