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Pre-Op History and Physical

  1. Default Pre-Op History and Physical
    Clearnace Sale
    Is it normal for a pre-op history and physical to be scheduled for two weeks prior to an arthroscopic surgery and be billed as a separate e/m visit? Here is the scenario that we are dealing with:
    Decision for surgery is made during an office visit and the surgery is scheduled the following month and a level four or five office visit is billed.
    A pre-op history and physical performed by the surgeon takes place at the location of the surgery approximately two weeks prior to the surgery and the insurance company is billed for a level five office visit.
    I know that the guidelines state pre-op care should be included in the global surgical package for the day before or day of surgery, but is the surgeon circumventing the surgical package by scheduling the pre-op visit so far in advance? I appreciate any help I can get with this!

  2. #2
    Milwaukee WI
    Default Circumventing the rules
    The surgeon is trying to circumvent the rules and is commiting fraud. The pre-operative H&P is ALREADY being PAID as part of the reimbursement for the surgery. Scheduling it a week or more in advance to get around this rule is out and out wrong. I have no problem with the visit being scheduled in advance to ensure there aren't any issues that would preclude going forward with surgery. But you should not be charging for this visit. It is global to the surgery.

    F Tessa Bartels, CPC, CEMC

  3. Default
    I agree 100%. Unless a totally separate problem is discussed, this visit would be included with the surgery. The provider was already paid for the E/M when the decision for surgery was made.


  4. #4
    Greater Pittsburgh
    Agree, included in the surgical package.
    jdemar, CPC, CMA

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