Wiki Please help

[CATALINA J]

Before surgery the doctor need to have a history and phisical requested by hospital. But the code we use (exe.99396) it's getting denied becuse the dr is a specialist. Please help me understand how should we code and bill this situation. Thank you

 

[creativecoworker]

For a Pre-operative Clearance Exam, we use an E/M CPT code that the documentation supports and Dx code V72.83 and then reason for surgery (example cataracts, carpal tunnel). Hope this helps.

 

[vdockum]

I agree that a E/M code for admission is used vs 99396 which is for preventive medicine reevaluation. If the pt. is admitted inhouse 99221-99223 with an appropriate modifier should be used. If the pt. is an observation pt. the 99218-99220 series should be used. If the pt. is having an outpt. surgery (in and out) the last H&P from your office within the previous 30 days should appear in the patients medical record for this procedure. I hope this helps. Thanks