Advanced Search

Primary Care Coding Alert

You Be the Coder In-Depth:

Pre-Op Clearance Yields Consult Opportunity

Published on Thu Jan 27, 2005

Warning: Consider 3 items before assuming 9924x is the right choice

When you see the phrase "preoperative physical," a light should go off in your head that this may be the perfect time to use a consultation code.

FPs Typically Perform Pre-Op on Request 

That's just what some astute FP coders thought when they read Family Practice Coding Alert's January 2005 "You Be the Coder: How to Code 3 Pre-Op-Added Services," which focuses on reporting three procedures related to a pre-op physical. The scenario didn't address coding the preoperative physical.
 
The omission left some coders wishing for more. You could bill the example's main E/M service - a preoperative visit - as a consult, such as 9924x, writes Beth Dutcavich, billing manager at Integrated Medical Group in Pottsville, Penn.
 
Why: Family physicians (FPs) typically provide preoperative clearance exams at the request of another surgeon. The FP doesn't usually perform the surgery.
 
But when considering reporting a consultation in the "You Be the Coder" ("YBC") scenario - or in your daily coding - you should look at three additional items:

1. Consultation Requires 3 R's

Before assigning 9924x for a pre-op exam, you should check that the service qualifies as a consultation. You may code a pre-op exam with the appropriate office visit consultation code if the encounter meets these criteria:

 1. a surgeon requests the visit
 2. the FP renders his opinion
 3. the FP issues a report back to the surgeon.

Action: Start looking at consultation codes if another physician requested the FP's opinion or advice on the patient's ability to undergo surgery, says Barbara E. Oviatt, CPC, CCS-P, coding supervisor at Martin Memorial Medical Group in Stuart, Fla. In real-world coding, you also "will want to know who the requesting physician is and if he/she received a follow-up report," she adds.
 
Exception: In a hospital setting, the FP doesn't need to send a report to the requesting physician. Documentation in the shared medical record suffices as the report.
 
Practice step 1: Take for example the "YBC" scenario in which an FP performs a preoperative physical with an electrocardiogram (ECG), a Depo-Provera injection, and an ear flush on a Medicare patient. Suppose the question stated that a general surgeon requested the FP's advice on the patient's suitability for undergoing cholecystectomy and that the patient's shared medical record contains a report of his findings to the general surgeon. You would know that the encounter meets a consultation's three requirements and could consider which code to use.

2. Location Determines 9924x or 9925x

Before you can choose the right consultation code, you'll also need to know where the service occurs. "Physicians typically perform preoperative-clearance services in the office, but these services can also apply to other locations including inpatient places of service,"  Oviatt says.

Depending on whether the FP performs the pre-op exam in an outpatient or inpatient setting, you should look to one of these code sets:
  

  • for office or other outpatient consultations, use 99241-99245 (Office consultation for a new or established patient ...)
      
  • for inpatient consultations, use 99251-99255 (Initial inpatient consultation for a new or established patient ...).

    Apply step 2: Suppose the "YBC" question specifies that the FP performs the preoperative physical on a hospital inpatient. In this case, you should choose the appropriate consultation code from the 9925x series.

    3. Elements Pinpoint Exact Code

    To arrive at the right 9925x code, you need one more piece of information. "You need to know all the standard E/M elements," says Quinten A. Buechner, MS, MDiv, CPC, CHCO, president of ProActive Consultants LLC in Cumberland, Wis. This includes what level history, evaluation and medical decision-making the FP performs and documents.

    Complete step 3: How would you code the YBC scenario if the question states that the FP performs an inpatient consultation involving an expanded problem-focused history, expanded problem-focused examination and straightforward medical decision-making? The E/M elements should lead you to choose 99252.

    • Other Articles in this issue of

    Primary Care Coding Alert

    View All