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Thread: Out Patient Hp Pre Op

  1. #1

    Default Out Patient Hp Pre Op

    AAPC: Back to School
    how would you bill a outpatient hp pre op to medicare we are using 99242-56does anyone have any info on how this should be coded?


  2. #2
    Join Date
    Apr 2007


    If your provider is not performing the surgery, then you would code the v72.8x with any condition found during exam with a regular office visit 992XX-56. Is it a pre-op consult by a speciality provider? Does he give a recommendation? Is the consulting provider noted in the documentation? If not, then the E&M would be a 9921X for established patient or 9920X for established patients.

  3. #3
    Join Date
    Apr 2007
    Milwaukee WI

    Default Are you the surgeon?

    If you are the surgeon then you should not be separately coding a pre-op H&P visit, even if it's done in the office a few days in advance.

    If you are the Primary doctor and have been asked by the surgeon for a consultation (for a specific reason ...example: diabetic patient who is scheduled for knee replacement), then you can code the appropriate level consult. No need to append the -56 modifier.

    If you are the primary doctor and the surgeon is just dropping this hospital requirement in your lap, then I'd ask the surgeon to complete a request for a consult. If there's no medical condition that warrants a consult, I'd explain that I can't possibly provide this as there is no medical necessity for my seeing the patient. This is the surgeon's / admitting physician's responsibiliy.

    F Tessa Bartels, CPC, CPC-E/M

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