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hland

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I have a billing/coding question. We have a Care Plus (managed care option for Mediare) pt that came in for a Pre Op visit. I coded the reason for the surgery first then the pre op code. They are not liking the E/M code. The doctor used 99397 and they don't like it. Would it be billed out like a regular office visit or would one of M'care G codes work. If someone knows the answer I'll be your new best friend. :)

Thank you
 
Pre-op clearance is not a preventive visit, so the 99397 (never a covered service by Medicare) is not appropriate.

Code an E&M visit 99201-99215. Pre op visits are coded with V72.84 primary, the reason for surgery is secondary, and any comorbitidies reported as the reason for the medical clearance are coded after that. There is coding guidance in the front of ICD-9 that walks you through this.

If the patient is non-medicare, and the surgeon asked for an opinion, you can bill a consult code.
 
I'm confused

Are you saying that you (facility) can bill for a routine pre-op H&P for a scheduled surgery, testing (like bloodwork, EKG) etc without the request for a specific pre-op clearance? Like if the patient has a heart condition, and you want him/her checked out, I can understand a separate consult and test. But what about routine work - what do you bill for the H&P using V72.83 or V72.84? or the bloods? I thought this testing was included in the RVU for the procedure. Am I mistaken?
Thanks
 
Maria Sekar, LPN,CPC

Thanks Pam, this information was very informative to me.




Pam Brooks said:
Pre-op clearance is not a preventive visit, so the 99397 (never a covered service by Medicare) is not appropriate.

Code an E&M visit 99201-99215. Pre op visits are coded with V72.84 primary, the reason for surgery is secondary, and any comorbitidies reported as the reason for the medical clearance are coded after that. There is coding guidance in the front of ICD-9 that walks you through this.

If the patient is non-medicare, and the surgeon asked for an opinion, you can bill a consult code.
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