Neurology & Pain Management Coding Alert

Question: What CPT^® code should we submit when a surgeon requests pre-op clearance by one of our physicians? Is the service payable by insurance?

Wisconsin Subscriber

Answer: Yes, this is a billable service. How you report the visit depends on the payer.

For Medicare patients requiring pre-op clearance, report the appropriate E/M code based on your physician’s documentation of the visit. Most patients in this situation probably will be established with your practice, which means you’ll chose from 99212-99215. If the patient is new, select from 99201–99205.

If the service is performed in the inpatient setting, you’ll report an initial or subsequent hospital care code instead (99221–99223 or 99231–99233).

Non-Medicare: If the patient’s payer still accepts consultation codes, follow CPT^® instructions for reporting consultation services with 99241-99245 for a new or established patient in your office, or 99251-99255 for a new or established patient in an inpatient setting.