Wiki Pre-op / Post op visits

[MCornell87]

Hi there, I need some guidance as to coding for post-op / pre-op E/M visits:

Scenario #1:

s/p tonsillectomy 9/30/14 (initial post op visit on 10/27/14)

Problem #1: PHARYNGITIS, ACUTE, RECURRENT

Problem #2: ECZEMA

**Should I bill a 99024 OR the established CPT code of 99213 with a modifier being the physician address the eczema also?
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Scenario #2:

initial consult with cardiologist for pre-op evaluation (colonoscopy & abnormal EKG)

Problem #1: PRE-OP CARDIAC CLEARANCE
Problem #2: OLD MYOCARDIAL INFARCTION
Problem #3: ABNORMAL EKG


**Based on the guidelines this should be coded as a consultation, correct? and NOT a new patient/established code due to the patient didn't request the consult?

Thanks so much in advance for any guidance on this

 

[Orthocoderpgu]

First scenario: Bill 99213-24 with the diagnosis for eczema. Forget about the 99024 code. The -24 modifier tells the insurance company that the patient was treated for a medical condition that is not related to the surgery, so there is no global for this condition.

Second scenario: You seem confused on consult codes, and it has nothing to do with a patient request or not. Neither of these situations fit a true consult, which is why CMS and about half of private payers don't process consult codes any longer. In an audit 95% of consults billed did not meet the requirements for a consult for three consecutive years. A consult is when a physician needs the expertise of a more experienced physician in order to treat a patient. This is not for medical clearance for surgery. The physician should just bill a regular office visit.