Wiki Pre-op Visits

[Cwirtalla]

My practice Ortho practice is looking into possibly adding a PCP or an APRN, to preform our pre ops in house. Does any other practice do this? I am also wondering what the reimbursement for a pre op would be, and what codes are usually billed for this service.

Any insight would be greatly appreciated.

Thank you
Corey W.

 

[nraizman@gmail.com]

Many practices used to do this, but those visits are generally not reimbursable.

 

[nraizman@gmail.com]

To clarify, there is a discrepancy between CMS, CPT and private payors as to when the Global Period begins.

Once the Decision for Surgery has been made, preop visits are generally considered within the Global, even if, nominally, CMS says the Global begins the day before surgery. In practice, these pre-op visits are denied.

Pre-op risk stratification is a different beast but not typically done by your employed NP.

And can you make a “provisional decision for surgery, pending medical clearance, labs, etc” and then have your pre-op visit be “final decision for surgery”? This is controversial, and potentially risky to bet the FTE salary of an NP on it.

 

[Mluong]

Typically, a procedure code includes pre-op, intraoperative and post-op. The global period starts the day before the surgery. That is why if a decision for surgery is done during the visit the day before or same day as the procedure will need to be appended modifier 57. At some clinic I worked at, pre-op can be done by a registered nurse when patient is given pre-surgical instruction and sign paperwork. If patient needs clearance from PCP or other specialty (such as cardiology), these providers can bill their services for pre-op clearance. So, hiring a PA or APRN to perform pre-op only might create a hefty cost to the practice because the visit is not separately paid.