Wiki Pre-anesthesia evaluation diagnosis code for a separately reported E/M

[alopez626]

What diagnosis code would be reported for a pre-anesthesia evaluation/pre-operative history and physical examination that falls outside the scope due to complex medical co-morbidities that is separately reportable with an E/M code? Would Z01.818 be appropriate with the chronic conditions as secondary? Or would the chronic conditions be the only diagnosis codes reported? Thank you

 

[LisaAlonso23]

If you're looking to bill an E/M separately from the anesthesia service strictly due to the patient's poor health due to complex co-morbidities, please know that the E/M is not separately billable regardless of the patient's medical status. The H&P is bundled.

 

[lschock79]

@alopez626 You are correct in your with Z01818 as your primary. Next should be the reason for the surgery (ie M1711 for a TKA) and then the chronic conditions leading to the need for a separate pre eval.