Wiki Billing for pre-op after decision made?

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lindsayroper

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Our ENT clinic also does surgery on patients.
Here's the dilemma: Our Dr's will first see the pt, decide to do surgery, and have the pt come back for a pre-op visit several days before surgery (the same Dr that decided to do surgery is the one doing the pre-op visit). This "pre-op" visit has been billed out as a regular e/m visit (level 3 to 4).
Should this visit be separately billable when the surg has a 90 day global? Under what circumstances would this extra visit be billable?
 
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I disagree, once the decision for surgery is made, the preoperative visit is a part of the global regardless of whether it is a day or 3 days prior to the surgery. The medical necessity is determined at the first encounter when the decision is made, you cannot charge for another encounter for the exact same thing. To make sure the patient's condition is still fit for surgery is all a part of the surgical procedure.
 
mitchellde said:
I disagree, once the decision for surgery is made, the preoperative visit is a part of the global regardless of whether it is a day or 3 days prior to the surgery. The medical necessity is determined at the first encounter when the decision is made, you cannot charge for another encounter for the exact same thing. To make sure the patient's condition is still fit for surgery is all a part of the surgical procedure.
Click to expand...

You are absolutely correct!
 
(from original posting) I think it's fraud to be charging out the pre-op visit like we are. We are getting paid and no insurance has really called us out on it, so it's been hard trying to find documentation/reasoning on why we shouldn't do it. Another argument FOR charging out the pre-op visit is our clinic is in a unique situation being a specialty clinic....
 
If the intent of the visit is for Preop, the service is included in the surgical package and not reportable; regardless of when the surgeon makes the decision for surgery. Being a specialty clinic is not relevant to the guidelines.

CPT Asst May 2009, page 9, 10 Category Clarification

If the surgeon sees a patient and makes a decision for surgery and then the patient returns for a visit where the intent of the visit is the preoperative H&P, and this service occurs in the interval between the decision-making visit and the day of surgery, regardless of when the visit occurs (1 day, 3 days, or 2 weeks), the visit is not separately billable as it is included in the surgical package.

See this previous forum posting string.
https://www.aapc.com/memberarea/forums/showthread.php?p=289543#post289543
 
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