We actually just had this issue pop up and I'm so happy I found this thread. One of our doctors said that Medicare wouldn't pay for pre-ops, so they were putting a code in that is $0 charge (99024/99025). So one of the coders brought it up to the PA that typically does this doctor's pre-op appointments. So the issue is that these pre-op visits are NOT the decision for surgery, but the PA is spending at least 20 minutes with these patients talking specifically about the surgery and giving them education on everything they need and answering their questions... I understand if they're wanting to include it in the payment for surgery, but is there ANY way we can charge for this ethically? And is this only for Medicare? Or do a lot of insurances follow this? I'm not trying to do anything wrong, but when these patients come in for their MRI results, that's when the doctor decides to proceed with surgery since he can see what's going on, but it's after that that this pre-op visit is happening where it's actually being thoroughly discussed and everything. We're putting the Z01.818 on the visit, but not mod 57 unless it's the day before or the day of surgery. I hadn't heard anything about this until now and want to fully understand what we can do to charge for it without getting in trouble of course, or if it's just a lost cause... I don't want to tell these doctors it's a lost cause and by the way hey, that full day of clinic your PA or NP is having is for free. You know? I mean they should be paid for the amount of time and education they're giving I would think, but I'm not going to continue charging for these if it's flat out wrong. I mean does the time frame that this happens matter? This PA is doing them at least 3 days prior to the surgery... sometimes it's earlier.
Hi can you include Chronic conditions in as a 3rd or 4th dx. Example Pt present for preoperative cardiovascular exam. He has a history of htn with moderate ckd. He is scheduled for a total hip replacement for degenerative osteoarthritis of the right hip. Can I code the Z code then the reason for surgery and include the HTNCKD and the stage or only report the z code the reason for surgery and any findings if found?
It sounds like standard pre-op to me. Yes, patents have a lot of questions, but what they are discussing has no bearing as to whether the surgery is necessary or not. Now if the operation is cancelled, then it may become billable. They are not providing services free of charge. They are being paid for it through the surgery reimbursement. The surgical RVU includes a pre-op, interop and post-op component. The pre-op component is going to the visit you are describing by the PA
The timing of when it's performed doesn't determine if its billable or not. The decision for surgery can be made months in advance.If the visit is unrelated to the surgery, then it can be billed separately, if it's related then no. Global surgery is not a Medicare concept; it's a CPT concept, so it applies to every payer.