08-10-2017, 08:02 AM | Community Wiki

Page 2 of 2 FirstFirst 12
Results 11 to 12 of 12

Pre-Op Physicals - chronic conditions

  1. #11
    Exam Training Packages
    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
    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 03:51 PM.

Page 2 of 2 FirstFirst 12

Similar Threads

  1. Pre-op physicals
    By plschmacht in forum Medical Coding General Discussion
    Replies: 4
    Last Post: 12-15-2014, 01:59 PM
  2. Pre-Surgery Physicals
    By fferali in forum Pediatrics
    Replies: 2
    Last Post: 09-25-2014, 05:57 PM
  3. pre-operative physicals
    By mrolf in forum E/M
    Replies: 11
    Last Post: 07-09-2010, 11:59 AM
  4. Pre-Op Physicals
    By Coder81 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 07-09-2009, 01:24 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.