Wiki Preop During Routine Exam

[MICHELLE1279]

Visits booked exclusively for Preop exams are generally coded as consults without a problem. However, I am being asked if she saw the patient for a routine 2 yr well child check, and also completed a preop exam/form/and written documentation to the surgeon if she can bill both the routine exam and the consult. The routine exam is well documented, as well as the clearance for surgery and referene to the note she sent to the surgeon.

 

[dmaec]

can you score the consult out independently of the preventive service? Is this just a hospital required pre-op clearance or does the child have some "issue" that has to be reviewed due to the surgery coming up? (asthma, heart problems, etc??)

 

[kellyross]

consult vs. well child care

My first thought is that these are two separate exams.

One is a pre-op clearance, requested by the surgeon...which is clearly a consult code, as you mentioned.

If the pediatrician is also choosing to provide Well Child Care at the same visit, I would think that Modifier 25 would come into play.

So, we have the Well Child Exam - Modifier 25 and your V20.2 diagnosis and the Consult with your V72.84 (or whatever applies). I see no reason why you should not be paid for both, as long as the documentation supports that.

However, always check with the payer.

Our physician would be more inclined to bring the patient back for a separate visit to do the Well Child Exam or vice versa. Since neither visit is acute, this decision could also be placed on the patient (parent) as to which visit they would like to have performed at that encounter. Always the safest.