For now go with the consultation code, as long is all the requirements are met.
Example:From the American Academy of Family Physicians
Preoperative clearance
It's not uncommon for a surgical specialist to request preoperative clearance from the patient's family physician. As with other consultation services, the preoperative clearance consultation should involve a request for opinion or advice. For example, do the comorbid conditions of this patient require any special considerations? Can this patient safely undergo this procedure?
When you report a consultation for preoperative clearance, use the appropriate CPT code for the level of service and setting where the consultation services were rendered as well as diagnosis codes that indicate the necessity of the consultation. Select the appropriate ICD-9 code from the V72.81- V72.84 series (V72.81 for preoperative cardiovascular exam, V72.82 for a preoperative respiratory exam, V72.83 for another specified preoperative exam or V72.84 for an unspecified preoperative exam) and a second diagnosis code to indicate the condition for which surgery is intended. Also code any diagnoses that arise during your consultation.
Medicare guidelines state that if, following a preoperative consultation, the consultant assumes responsibility for managing a portion of the patient's condition(s) during the postoperative period, the consultation codes should not be used. In this situation, you should use the appropriate subsequent hospital care codes to bill for the concurrent care in the hospital setting and use the appropriate established patient visit codes for services provided in the office.
If you perform a postoperative evaluation of a new or established patient at the request of the surgeon, then you may bill the appropriate consultation code for E/M services furnished during the postoperative period. The stipulations are that all of the criteria (the four R's) for the use of the consultation codes must be met and you must not have already performed a preoperative consultation.
You may not bill a consultation if the surgeon asks you simply to manage an aspect of the patient's condition during the postoperative period, because the surgeon is not asking for your opinion or advice in treating the patient. Instead, your services would constitute concurrent care and should be billed using the appropriate subsequent hospital care codes, subsequent nursing facility care codes or office or other outpatient visit codes, depending on the setting. (To learn more about concurrent care coding, see "A Refresher on Medicare and Concurrent Care," FPM, November/December 2005.)