Charging for Pre-Op H&Ps
Q I have coded for 30 years and still am not comfortable with what to do about history and physicals done preoperatively. I pretty much stopped charging for H&P when I read an article that stated, â€śIf the H&P is done for hospital regulations then you cannot charge.â€ť But now I hear other practices are charging for pre-op exams. Whatâ€™s the real story?
A Medicare will pay for preoperative clearance exams if the exam is medically necessary (not just done because the hospital says you should), isnâ€™t covered under the global, and meets the documentation requirements of the service billed. Look at page 16 of this transmittal, which spells out Medicareâ€™s policy.
Of course, many of the H&Ps you may be doing are covered under the global. This is defined in CPT in the comments that define the surgical package. Youâ€™ll find them at the front of the surgical codes in your CPT book. The basics:
An E&M on the day of or the day prior to surgery is included in the surgical package unless that is the visit that led to the decision for surgery.
Additional reimbursement for preoperative E&Ms is usually allowed prior to the decision for surgery to establish the need for surgery. This is what CPT says, but your payers may have their own rules. Youâ€™ll have to check your contracts and denial codes for those.
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