office visit and consult code

[lziemnicki]

We had a patient come in for a office visit for constipation. during that visit the provider also did a pre op exam. Can you bill for both the E/M level and a consult code for the Pre-Op? or would you just use a E/M level?

 

[ardithch]

Most payers will not accept the consultation codes 9924X and 9925X anymore. However, the code choice also depends if you are a specialist or not. Was the patient referred from the PCP to your office? What it a new patient or an established? For Medicare and most payers, you'd bill the appropriate E/M code.

Hope this helps!

Ardith, CGSC

 

[CodingKing]

Pre-op visit is bundled in the surgery. Since they are related issues, you are limited to 1 E&M per day per provider group.

 

[mhstrauss]

Pre-op clearance by PCP is not the same as a pre-op visit with the surgeon. In general, if a surgeon requests clearance by the PCP, as long as the payer still accepts consult codes, then yes, a consult could be billed. However, as the first response states, you can only bill one E/M per day.