Anesthesia Coding Alert

Question: Our physicians must write the history and physical (H&P) for surgery on podiatric patients since the podiatrists cannot. I have been billing E/M 99201, but the insurance companies reject it, saying it is incidental. Is there any way I can get reimbursed for doing this H&P for the podiatrist?

Texas Subscriber

Answer: The presurgical H&P is often a facility requirement and considered by many payers as not a medical necessity -- that is, not separately payable. A preoperative anesthesia evaluation is required and included in the global anesthesia fee as part of the base units. Generally, avoid appending modifiers to an E/M code such as 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem[s] and the patients and/or familys needs. Usually, the presenting problem[s] are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family) when part of the anesthesia base unit payment is a pre-anesthesia evaluation.

Best bet: Check with the facility and the podiatrist to see who they can arrange to perform the pre-surgical H&P. Some facilities have in-house non-physician providers (such as a nurse practitioner [NP] or physician assistant [PA]) perform the H&P while others make arrangements with either the patients primary care provider or other physician since it is the facilities bylaws that wont allow the podiatrist to perform the required pre-op H&P.

Note: This H&P goes beyond what the anesthesiologist typically performs. Some payers may not cover it.