Wiki Pre Op Coding

[jpeace01]

I have a patient who came in for a pre op exam one of our infectious disease physicians and there is no active infection to be reported. The physician has listed primary code Z40.8 Encounter for Other Prophylactic Surgery, which has been denied. Would Z01.818 Encounter for Other preprocedural Examination be an appropriate code to bill as primary in this situation?

Thank you!

 

[thomas7331]

Z40.8, as the code description indicates, is an encounter for a surgical procedure, not for an exam. Z01.818 would be correct for a pre-operative exam, such as one requested from a specialist for pre-operative clearance, unless the documentation shows that there was another problem or question that needed to be addressed that was the primary reason for the visit.