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Thread: Pre surgical examination...what do we bill?

  1. #1
    Join Date
    Apr 2007

    Default Pre surgical examination...what do we bill?

    AAPC: Back to School
    A patient is having dental surgery, that requires the patient to be put out. Since it's being done under this anesthesia, the surgeon requires a full physical examination done 30 days prior to the procedure. This particular patient just had an examination done in March 2010.

    What E&M code do we bill this pre-operative examination as?

    Tiffany Fischer, CPC, CEMC

  2. #2
    Join Date
    Apr 2007
    Albany, NY

    Default It depends on the insurance...

    Since you're presumably being asked to assess whether or not the patient is a candidate for general anesthesia, this is a consultation (request for advice or opinion) 99241-99245 however, if the patient has Medicare or Medicare Managed Care (depending, not all have this rule but most are following Medicare) then you would select the new 99201-99205 or established patient code 99211-99215 as appropriate based on the 3 year rule. If your physician or a member of the group practice of the same specialty HAS NOT seen the patient (including as an inpatient) then they are considered new 99201-99205.

    This article is a little out of date because it doesn't take into consideration the above 2010 consultation coding change, but it will help you with your ICD-9's:


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