Gastroenterology Coding Alert

Question: Our gastroenterologist handled the preoperative consultation for a surgical case and was asked to see the patient again after surgery. Can we bill an E/M service for this? Washington Subscriber Answer: If the surgeon asks the gastroenterologist back after surgery, you can bill an E/M service for this. Whether you can report a consult depends on the payer. CPT has no limitation on the use of consultation codes before and after surgery. On the other hand, Medicare would not consider the post-op visit a consult. Medicare does not allow an outpatient preoperative consult followed by a postoperative consult for the same diagnosis(es) on the same patient. According to Chapter 12, Section 30.6.10(H) of the Medicare Claims Processing Manual (MCPM): "A physician (primary care or specialist) or qualified NPP [non-physician provider] who performs a postoperative evaluation of a new or established patient at the request of the surgeon may bill [...]