Wiki Pre procedural exam for Medicare Pt

[Radcoder86]

I have a doctor that performed a preprocedural exam on a Medicare pt and the only dx he gave me was pre op medical exam. He specifically stated the pt had no complaints. The procedure that pt is having is a radical prostatectomy for a cancer diagnosis. From what I understand, Medicare will not cover Z01.818 (encounter for other preprocedural exam). I'm not sure how I should go about billing this. Help, please.

 

[thomas7331]

Medicare does cover medically necessary preoperative exams - you shouldn't have any problems with this. You'd code the Z01.818 as the primary diagnosis and the cancer as a secondary code. Even if it was not covered, you'd still have to code it this way was if that's what was documented, but I've never had any problems with Medicare paying for a pre-operative exam in recent years.

 

[Radcoder86]

Oh, okay, thank you. Everything I was reading said it wouldn't be covered. He didn't add the cancer as a dx though...