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pre and post-op billing

cmac

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Messages
47
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0
does anyone have experience billing for pre and post-op? i work for a family practice physician who does a lot of pre and post op including labs and most times a hospital stay. when we had our billing company they had us fill out a form and fax it to the surgeon's office stating they'd bill with a modifier showing surgery only not pre and post-op then we'd bill with the pre or post op modifier using the CPT they put down on the form - most surgeon's offices would not fill this out they'd bill for the entire thing so we started billing a 99213 or 99214 and got paid that way instead of fighting with the surgeon's office; we are no longer using these forms. i feel we could be losing money by not doing this. we bill a pre-op consult and sometimes we get paid sometimes we don't, from what i have seen using a 56 modifier on the 99243, etc does not get paid, gets denied. does anyone know the proper way to bill?
 

LOVE2CODE

Expert
Messages
392
Location
Alexandria, VA
Best answers
0
does anyone have experience billing for pre and post-op? i work for a family practice physician who does a lot of pre and post op including labs and most times a hospital stay. when we had our billing company they had us fill out a form and fax it to the surgeon's office stating they'd bill with a modifier showing surgery only not pre and post-op then we'd bill with the pre or post op modifier using the CPT they put down on the form - most surgeon's offices would not fill this out they'd bill for the entire thing so we started billing a 99213 or 99214 and got paid that way instead of fighting with the surgeon's office; we are no longer using these forms. i feel we could be losing money by not doing this. we bill a pre-op consult and sometimes we get paid sometimes we don't, from what i have seen using a 56 modifier on the 99243, etc does not get paid, gets denied. does anyone know the proper way to bill?


The correct way to bill Pre op--

DX-1) V72.8_
2) plus any other medical dx's (hypertension, diabetes, etc)

CPT-1) 9924_(NO MODIFIER ON CONSULT CODE)
2) labs
3)any other test needed for pre op per surgeon
ekg-I think you have a modifier on this

Make sure you have the surgeon name, speciality, npi, tax id, etc on claim and your claim will be paid correctly. Now don't forget the 3 R's.....

Post op--
is usually taken care of by surgeon however you as the family practice doc can see the pt anytime after surgery and code it as (992--) as long as you are following up on pt for the other medical dx's....


Hope this helps....

YTH, CPC
 
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