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pre-operative physicals

  1. #11
    Rose City (Portland, Oregon)
    Medical Coding Books
    I think loptas brings up a good point. If the patient is otherwise healthy, why is clearance needed? If there is medical necessity for a visit, it could be a consult if the surgeon is requesting the advice from the PCP (as in the HBP example above). I would not consider it to be part of the pre-op global package because the PCP is not doing the pre-op if his advice is being sought.

    Good question and debate!

  2. Default
    We too are looking into this and I'm so glad the modifier 56 was mentioned. I was trying to find some guidance in how it should be reported, as CMS IOM only provides direction for use of the 54/55 modifiers. Sounds like it should be applied to the surgical procedure code, is that correct? We have NPP's providing the required pre-op anesthesia clearance for dental surgeons, since I'm told it is not w/in their (dentists) scope of practice to provide the h&p. I agree that the NPP's should not being billing an E/M visit for this (consult or outpt visit), since a preop h&p is considered part of the global payment.

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