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Thread: Pre-Op Physicals

  1. #11
    Join Date
    Apr 2007


    AAPC: Back to School
    I see where all of you are coming from, and it's good input.

    But flip the coin on the other side of this scenario, say the surgeon is an orhto and he is going to do a procedure on a patient with multiple chronic conditions. It's only naturally for the surgeon to send them back to there PCP and make sure he/she is fit for surgery.

    Orhto/Any other surgeon have no business evaluating chronic conditions.

    Plus Medicare has direct us to use the consult codes when a Pre-Op clearance is request and all the three R's are met.

    Either way this is going to be an old debate come next year with medicae not paying on Consults anymore, plus I'm sure the PPO's insurances will follow suit soon.


    Medicare Carriers Manual 15506 states: “Pay for the appropriate consultation code for a pre-operative consultation for a new or established patient performed by any physician at the request of a surgeon, as long as all the requirements for billing the consultation codes are met.”

  2. #12
    Join Date
    Apr 2007
    Milwaukee WI

    Default To daniel

    You are right about requesting a consultation for co-morbidities. But the original poster specifically stated that this is a "non-Medicare patient with no chronic conditions" (i.e. healthy patient) for which the surgeon is expecting the PCP to perform the H&P. In such a scenario this is NOT a consultation. And it doesn't merit an established visit code either. There is no medical necessity for the PCP to perform this service, which is an integral part of the surgery and for which the surgeon is being paid.

    F Tessa Bartels, CPC, CEMC
    Last edited by FTessaBartels; 11-13-2009 at 02:51 PM.

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