Pre-Op
The pre-op clearance is tied to the surgery/procedure. If it is performed by the surgeon, it is considered part of the "global fee" for the procedure. Ethically, there is no way to circumvent this.
If the patient is sent to a specialist of to his/her PCP, for a pre-op clearance, the V code has to be in the 1st dx position, the DX code that is tied to the auth and is the reason for surgery is always in 2nd place and any relevant findings are in 3rd and 4th.
For example, V72.81 Cardiology Clearance, V72.82 for Respiratory, V72.83 for Other Specified Exam (Diabetes, long-term use of high risk drugs, etc0 followed by the reason for the surgery/procedure and the specified reason for the exam in 3rd position and any incidental finding in 4th) a V72.86 for blood typing would be used only for the lab testing and an E&M visit wouldn't be appropriate as is the same for the V72.6 Lab exam code.
The E&M would be determined if the patient was a New or Established patient or if there was a written request for a consult to clear this patient for the surgery/procedure.
If the pre-op is a generral exam that is done in the course of the surgery or procedure, the surgeon or specialist will have to suck it up and not unbundle what is paid for in the global fee.
Of particular note is that in Work Comp cases, the Diagnosis that is attached to the WC Claim has to be in 2nd position after the Pro-op screen or consult or the consult/E&M visit will not be covered. The finding from the E&M /Consult has to be in 3rd and 4th for WC to cover pre-op clearances.
This seems difficult for some specialists to understand because if they are seeing this patient for a respiratory clearance and the patient has COPD but the surgery/procedure is being done for a hip or back injury, the Pulmonologists believe the COPD is the reason for the consult not the back or hip injusy. Doesn't matter, the auth is tied to the wC injury, not the COPD and if not billed to address the WC injury, the calim will be denied.