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Pre op E/M

  1. Default Pre op E/M
    Medical Coding Books
    I saw my doctor's PA 4 work days prior to my scheduled outpt surgery. I was charged an OV and was asked to pay my co-pay. I told the young girl that this was a pre op visit and should be no charge and she was addamant that I pay my co-pay. I don't code surgeries so am not that familiar with the pre op guidelines. I thought the guidelines stated w/in a week. Am I wrong?

  2. #2
    It's probably because you saw a different provider. If you saw your doctor for the pre op, and had already discussed everything about the procedure you were having, then no I don't think it is chargable.

    That is my opinion,

    Becky, CPC, CCS-P

  3. #3
    Global doesn't start until 24hrs prior to the procedure. This would have been billable for any provider, medical necessity is a whole different ball game though. If it wasn't necessary then that alone could throw it out in an audit by a carrier.

    Laura, CPC

  4. Default pre op
    Basically, the MA took my BP, temp, etc. I signed the consent. The PA came in and "reviewed" the stats. He never listened to my heart/lungs etc. I have been very unimpressed with him, although I love my doctor. I don't feel that I should be charged.

  5. #5
    You have the right to review your chart. You can challenge any billing they submit with your insurance carrier.

    I have a feeling that their documentation will probably support a 99212 or 99213 pretty easily. For an established visit they don't even have to do an exam, but by taking vitals that is actually an element of exam.

    I know how you feel, I had the same thing with one of my cardiologists. My insurance paid for me seeing him 4 times and I never even met the man. I saw PA's. This is wrong on a few levels and I am dealing with it thru my insurance.

    Good luck,

    Laura, CPC

  6. #6
    Milwaukee WI
    Default PA vs doctor
    Laura writes: I know how you feel, I had the same thing with one of my cardiologists. My insurance paid for me seeing him 4 times and I never even met the man. I saw PA's. This is wrong on a few levels and I am dealing with it thru my insurance.
    Many commercial carriers do not separately credential allied health providers (PA, NP). Rather the service is billed under the supervising MD's name. This is a legitimate bill (of course, I'm assuming the level of service billed matches the documentation of the PA... but that's another question.)

    Question for Pegburch: Who is performing this pre-op visit? Is it the surgeon's office? Or is it your PCP? If it's the surgeon's office, there is no medical necessity for the visit if the decision for surgery was previously made and this is scheduled 4 days prior just to "get out of" the global period. I would remind my surgeon that the payment for the surgery INCLUDES the appropriate pre-surgical E/M ... so s/he is ALREADY getting paid for this service.
    If it is your PCP at the request of the surgeon, then this may be a medically necessary visit and your copay may apply.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 07-23-2009 at 11:44 AM.

  7. #7
    Thanks Tessa for the response but my Blue Cross does credential them. Believe me I know, we had tons of fun getting our PAs credentialed thru them.

    Laura, CPC

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