Wiki preop visit

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cooper1

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I have a discussion going on in the billing office. Patient goes to general surgeon for problem surgeon decides to do surgery and tells the patient to go to their primary dr to get cleared for surgery. Patient goes to PCP for this. What e/m code do you use for the PCP visit?
 
For a routine clearance or because of a problem?

Routine I would use either a preventive code, if they have no issues, or the correct new/established code if they do have issues but it is still just routine.

If this is a non-medicare patient and they surgeon is actually waiting for the PCPs opinion on whether or not the patient is ok to have surgery I would use a consult code. If it is a medicare patient, you have to to go with the correct new/established code.

Laura, CPC, CPMA, CEMC
 
They are routine clearance but the surgeon waits to hear from the pcp. So rather the pt is having a problem or not they still get sent back to their pcp for surgery clearance and it all depends on what other problems the pt has on what preop tests are ordered from the pcp
 
Surgery code with -56 modifier

The reimbursement for every procedure includes an appropriate pre-operative evaluation and management service.

If the surgeon is sending the patient to the PCP for that "routine pre-op" service, then the PCP should use the primary surgery code with a -56 modifier (pre-operative care only). The surgeon will then code the surgery with a -54 modifier.

If there is truly some co-morbidity issue for which the surgeon needs the opinion/advice of the PCP ... e.g. patient is diabetic and ortho surgeon wants a pre-operative consultation from PCP re that issue ... then follow the consultation rules based on whether or not patient is covered by Medicare (or a payer who is following Medicare position on consult codes).

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
If a patient is going to another surgeon, what's the easiest way to get the surgery code? Do you have to call the surgeon's office every time there is a pre-op done?
 
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