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Pre op Clearance

  1. Default Pre op Clearance
    Clearnace Sale
    Patient is being seen for pre-op clearance and has no chronic conditions or medications. Basically the patient is perfectly healthy.

    He has a commerical non-Medicare policy. Due to the patient not having any chronic medical conditions what would require the PCP to evaluate and advise the surgeon on, this visit would be reported with the age appropriate E/M, V70.0, V72.84 and diagnosis code such as Osteoarthritis in the case of knee replacement. Lab and any other services would be reported to V70.0 or screening depending on family history. Would this be correct?

    Our Medicare Part B payer is WPS and if memory serves me correctly at the most recent E/M seminar this question came up in regard to a healthy Medicare beneficiary and the trainer indicated it would be considered a wellness visit and should be reported as such.

    What are the proper coding procedures.

  2. #2
    Maybe this is a dumb question, but if the patient is "perfectly healthy", why are they having an operation?
    Walker Bachman, CPC, CPPM

  3. Default
    No chronic conditions that require monitoring with medications or diet. I realize my statement is not very accurate for a person having surgery, but my problem is the patient may only be seen yearly for wellness exam.

  4. #4
    I still don't understand. Would you not use the same dx for the pre-op exam that the surgeon will use for the surgery?
    Walker Bachman, CPC, CPPM

  5. Default
    I guess my understanding the reason the surgeon sends the patient to his PCP for surgical clearance would not be as much related to the reason for surgery as to the patient's ability to tolerate a major procedure for conditions that may be present but have not been diagnosed. The surgeons reimbursment includes preop evaluation. The PCP is evaluating the general wellness of the patient, the surgeon has evaluated the reason for surgery. I would indicate on my claim V70.0, V72.84 and in the case of a total knee, 715.96 (osteoarthritis) when there are no other conditions being reported or evaluated that would influence this patients health surgically.

  6. #6
    OK, I see a little more clearly now. Sorry for being dense! I would just use the V72.84. I don't think the V70.0 is applicable to this situation.
    Walker Bachman, CPC, CPPM

  7. Default
    Would you report the age appropriate e/m as there is no illness being reported by the PCP, only the condition requiring surgery?

  8. #8
    Talking Pre Op Clearance
    When I coded for this situation, the Pre-Op clearance done by another physician other than the surgeon was due to the patient having a history of specific disease process. The V72.8 series with specificity to cardiovascular (V72.81), respiratory (V72.82) or other specified exam (V72.83) pre-operatively. I never used V72.8, V72.85 or V 72.9. Use of the V72.86 is exclusively for blood typing.
    The use of V70.0 isn't appropriate here as this clearance isn't for a wellness visit, but specifically for the patient's health status for a surgical procedure that could be a risk factor for anesthesia or for the procedure itself.
    I always coded the condition that was the reason for the surgical procedure in second place and if the exam was specifically related for the type of clearance, ie, COPD, Asthma, Long-term use of high risk drug, etc., that would go in third and fourth dx places.
    I never had a problem getting paid using this method. Just using the V code alone will not justify why the clearance outside of the surgeon's pre-op exam was necessary. Whoever is doing a specific clearance exam should be in a specialty or subspecialty that is not related to that of the surgeon.

  9. Default
    Thank you for your response. I was reading too much in to this as well as my confusion following a WPS E/M seminar. My concern was medical necessity for the E/M level with V72.8x as the primary dx code when no other conditions were present. I was told somewhere along the line the chronic conditions, Hypertension, DM etc, would be the diagnosis codes to report then V72.8x as well as the reason for surgery. Will lab reported with the V72.8 and reason for surgery be considered screening?

    Just want to do this correctly and clear up my confusion.

  10. #10
    Default Labs Done Pre-Operatively
    Labs should be coded the same as the exam..most insurance will cover the pre-op testing but they have to know it is pre-op. Also, the referring physician should always be the surgeon that will be performing the surgery. The authorization is tied to that provider and the diagnosis for the reason for surgery is also tied to the pre-auth. Sort of like a purchase order.

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