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Billing for pre-op visits is a national trend ???

  1. #1
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    Default Billing for pre-op visits is a national trend ???
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    I have an admin who is pushing some of the coders to find a way to bill for "pre-op" visits. The admin is under the impression that there is a legitimate way to do so. I have not heard anything like this and would like to hear from anyone who has "found a legitimate way" to bill for pre-op visits so I can understand where the admin is coming from.

    Personally, the pre-op visit is included with the AMA & CMS global surgical package, so this does not sound at all correct to me.

  2. #2
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    have you thought about coding the visit with E&M codes and use ICD-10 z01.818 encounter for other preprocedural examm as he first diagnosis? this icd10 lets the insurance co know pt is here for pre-op visit

  3. #3
    Location
    Salt Lake North
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    839
    Default That's not what I am hearding
    I'm not talking about billing a code that will not pay anything. I am hearing that there is a national trend where docs are billing pre-op exams with 99213 or similar, without a Z code and getting paid.

    I just want to know if anyone has come across this in their work.

  4. #4
    Default
    Misrepresenting what was performed to get reimbursement sounds like fraudulent billing to me.
    CRC (2018), CPC-P-A (2016), COC-A (2016), CPC-A (2015), PAHM (2010)
    Contract/Fee Specialist - Remote

    20 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

  5. Default Preop billing
    You can look to CPT Assistant for the answer to this. There is an article in 2015 that distinctly states that a visit after the decision for surgery was made that is for pre-op history and physical and obtaining consent is not separately reported. Hope that helps. Cindy

    Quote Originally Posted by Orthocoderpgu View Post
    I have an admin who is pushing some of the coders to find a way to bill for "pre-op" visits. The admin is under the impression that there is a legitimate way to do so. I have not heard anything like this and would like to hear from anyone who has "found a legitimate way" to bill for pre-op visits so I can understand where the admin is coming from.

    Personally, the pre-op visit is included with the AMA & CMS global surgical package, so this does not sound at all correct to me.

  6. #6
    Default
    There is always confusion regarding this modifier. The -57 modifier is not used when a physician decides that a patient requires surgery for an ailment; it is used when the physician determines that the patient is healthy enough to go under the knife (the "decision" that surgery will indeed take place).

    As in, a doctor can determine that a patient needs a knee replacement and schedules them for 3 months out. Because a lot can change in 90 days the physician may have several visits before the surgery, so the -57 modifier is reserved for the E&M that determines the patient is healthy enough and surgery will proceed not on the service that determined that they need surgery.

    Does that make sense?
    Carol Gaston CPC CRC CPCO

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