Pre op appt

Ash82

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If a surgeon sees a patient and makes the decision for surgery and schedules the surgery a month out and the pre op appt for 2 weeks out, can you bill for that visit? I have always understood that once the decision for surgery has been made, you can't bill for that office visit regardless of if the pre op appt happened one day prior or a month prior to surgery. I just read an excerpt from MLN Matters which makes me think otherwise. It states: "Medicare includes the following services in the global surgery payment when they provide them in addition to the surgery: Pre-operative visits after the decision is made to operate. For major procedures, this includes preoperative visits the day before the day of surgery. For minor procedures, this includes pre-operative visits the day of surgery". Am I reading this correctly? My surgeons now want to bill for every pre op appt. If someone can provide me with documentation that states otherwise I would greatly appreciate it!
 

CodingKing

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I was reading some older posts on this issue and it sounds as if the intent of the visit determines if an E&M can be billed separately. It can still be considered bundled if performed more than one day prior to the surgery. Otherwise almost every physician would purposely schedule pre-op 2+ days before the procedure for extra reimbursement. That kind of sounds like what your physician wants to do. I'm going to keep looking for a source. Hopefully some of our resident experts will have some additional sources. I'm sure this issue has come up thousands if not hundreds of thousand times in the past few years.
 

CodingKing

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I dont know if this is the most current but found this tidbit. If only they can get the quote function to work properly (Luckily i know BBB code from other forums i'm a member of) but here's a post in 2013 from OCD_Coder (cooler handle than mine). Unfortunately i don't have access to CPT assistant but sounds like the good info is in there.

https://www.aapc.com/memberarea/for...-billing-2-days-prior-surgery.html#post289543

PREOP VISITS – Guidelines **
Source: CPT Assistant MAY 2009 (AMA and CMS)

If the decision for surgery occurs the day of or day before the major procedure and includes preoperative evaluation and management (E/M) services, then this visit is separately reportable. Modifier 57, Decision for Surgery, is appended to the E/M code to indicate this is the decision-making service, not the history and physical (H and P) alone).

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 and 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.
 
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pscott

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So then what diagnosis code is correct to use, the pre op one,
or something else?
Thanks, I've been trying to get this all figured out.
 

CodingKing

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You shouldn't bill it unless its the decision for surgery (not clearance for surgery), in that case it would be the pre-op diagnosis. You don't want to risk getting paid for it then have the insurance or medicare come after you for billing things you shouldn't be billing for. I know there is a CPT code to report post op visits for information purposes but i don't think there is an equivalent for pre-op bundled visit.
 
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