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Pre-Op Exam vs. Consultations

  1. #1
    Post Pre-Op Exam vs. Consultations
    Medical Coding Books

    I was wondering if others are having, or had, the same issue I am having. Our clinic physicians always circle a consult code for a patient that comes in for a Pre-Op exam that another physician will perform. Now, according to the definition of "Consultation", I believe this choice is in error; that either an established or new E/M should be billed based on the definition of "Consultation"..............the surgeon is not asking their advice or opinion on the medical condition, they just want to know if the patient is physically able to go through a procedure. Am I correct in my understanding? I'd like some input before I ask the H.I.M Director if I can bring this to the clinic physician's attention. Thanks in advance!


  2. #2
    I have this issue sometimes, and you are correct. A pre-op that is just being done as a routine requirement before surgery is not a consult.

    Good luck,

    Laura, CPC

  3. #3
    Thanks so very much for your help Laura!


  4. #4
    We are a specialty clinic and frequently send our pts to their PCP for a preop visit. We were told that if a pt has any complex diagnoses such as Diabetes, Cardiac problems, or others that make the Pre op more complicated that we are to send a request for the pre op in written form and then the PCP may bill a consult code because it is a pre op that the specialty clinic MD would not be able to give a determination for fitness for surgery. I am not sure where my clinic director got this information from but that is what we are supposed to do going forward. Hope this helps.

    If anyone else can find other information on this please let me know.

  5. #5
    North Carolina
    Consultation for Preoperative Clearance

    Preoperative consultations are payable for new or established patients performed by any physician or qualified NPP at the request of a surgeon, as long as all of the requirements for performing and reporting the consultation codes are met and the service is medically necessary and not routine screening.

    Page 16.

    Again, it boils down to the intent and if the requirements are met....

  6. Default
    I work for an internal medicine practice and i had a sit down with the medicare representative from trailblazer my medicare contractor. If the specialist is requesting that we see the pt due to a medical condition ie diabetes we can bill a consult we have a form they fill out and fax to us. If they are requesting this for the reason of anesthesia requires it we cannot bill a preop in this instance and do not see these patients. The speciallists get paid a preop exam in their global package therefore there is no need for my doctors to do an additional exam on a perfectly healthy patient. We have alot of specialists who do not agree with this theory however this came straight from medicare and the office of the oig as the appropriate way to handle these. Hope this helps.
    Nicole wessell, bs, cpc

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