Anesthesia Coding Alert

Question: We have a podiatrist who comes to our facility to perform procedures. He cannot do his own pre-op evaluation/history and physicals (H&Ps) on his patients. The anesthesiologist often will be the provider completing the H&P. Is this a billable service by the anesthesiologist? Do we need to be sure the podiatrists
fee schedule has considered this and that he has modified his fees to reflect it?

Georgia Subscriber

Answer: Podiatrists cannot do H&Ps because they are not medical doctors (MDs) and do not have the necessary license or training. Most hospitals wont let them admit patients; the patients have to be admitted under another physician.

The H&P is still part of the pre-anesthesia workup. That may not seem fair because you have to do the full pre-op workup, but it is part of anesthesias base. Some hospitals have a written arrangement specifying who performs the H&P; it could even include the patients own physician. If another physician does the pre-op work, he or she can bill for it with modifier -56 (preoperative management only). The range of E/M codes would be 99201-99215, but many coding experts still recommend using the surgical code and then adding modifier -56. They would then bill a portion of the dollar amount based on the level of care provided. Many anesthesiologists lean toward the conservative side and consider the H&P part of the global fee. If your physicians want to bill for it, they should include -56 and the podiatrist should reduce his bill.