Wiki Pre-op clearance

[Dridgway]

what is the best way to bill a visit to PCP for Pre-op clearance?
If PCP is not the surgeon they would need to bill for services performed like E&M and EKG/xrays.
Pre-op clearance dx codes are not payable. Would you use the reason they are having the surgery for the dx codes?
Or, should surgeon be performing these services? I am told some patients need clearance from their PCP in order to have surgery.
Any help would be appreciated.

 

[csperoni]

The surgeon often does not clear the patient for surgery, that is done by PCP and sometimes a specialist (cardio, endo, pulm), particularly if patient has any underlying conditions (HTN, DM, COPD, etc.)
Why are the pre-op clearance dx codes not payable??
For PCP, your primary dx would be Z01.818, secondary dx the reason for surgery, then any additional for other patient problems.
Your CPT would be outpatient E/M 99201-99215 depending on new/established, and level of care. Years ago when consult coding was an option, those codes were typically used.
Are you receiving denials? If so, from which carriers, and what is the exact denial?

 

[Dridgway]

That is very helpful thank you. I have billed a couple but I thought the majority of z codes were not payable so I did not place any in the primary position. I used symptoms instead.
I was under the impression that because PCP is not doing the surgery, PCP should not use pre-op as primary dx. It appears that is incorrect.
I will give it a try, thank you very much!