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Thread: Pre-OP examanation

  1. #1

    Default Pre-OP examanation

    AAPC: Back to School
    Can someone help me? I work for Urgent Care and one of our Doctors say a 76 year old Medicare patient for a pre-op evaluation for cataract surgury. How should I code this. Should I code the procedure with a modifier 56 or should I code for a consult?

    Thanks for the help.

  2. #2

    Unhappy Urgent Care Center

    You being the Urgent care Center cannot do a preop examination.l Especially for Medicare. The primary care physician has to do the pre-op examination or the surgeon himself if he does not have a primary care physician. I hope this helps.

  3. #3
    Join Date
    Apr 2007
    Albany, NY

    Default Too late, you did one.

    I don't agree with "granny" 100%. I've never seen a reg that says that you CAN'T do one and are you a dual URG/PCP? I'd review this and try to submit it. If it's not payable, you'll learn something you can pass to your docs. If it is, now you know how to code it.

    Good luck.

    Preoperative clearance

    It's not uncommon for a surgical specialist to request preoperative clearance from the patient's family physician. As with other consultation services, the preoperative clearance consultation should involve a request for opinion or advice. For example, do the comorbid conditions of this patient require any special considerations? Can this patient safely undergo this procedure?

    When you report a consultation for preoperative clearance, use the appropriate CPT code for the level of service and setting where the consultation services were rendered as well as diagnosis codes that indicate the necessity of the consultation. Select the appropriate ICD-9 code from the V72.81- V72.84 series (V72.81 for preoperative cardiovascular exam, V72.82 for a preoperative respiratory exam, V72.83 for another specified preoperative exam or V72.84 for an unspecified preoperative exam) and a second diagnosis code to indicate the condition for which surgery is intended. Also code any diagnoses that arise during your consultation.

    Medicare guidelines state that if, following a preoperative consultation, the consultant assumes responsibility for managing a portion of the patient's condition(s) during the postoperative period, the consultation codes should not be used. In this situation, you should use the appropriate subsequent hospital care codes to bill for the concurrent care in the hospital setting and use the appropriate established patient visit codes for services provided in the office.

    If you perform a postoperative evaluation of a new or established patient at the request of the surgeon, then you may bill the appropriate consultation code for E/M services furnished during the postoperative period. The stipulations are that all of the criteria (the four R's) for the use of the consultation codes must be met and you must not have already performed a preoperative consultation.

    You may not bill a consultation if the surgeon asks you simply to manage an aspect of the patient's condition during the postoperative period, because the surgeon is not asking for your opinion or advice in treating the patient. Instead, your services would constitute concurrent care and should be billed using the appropriate subsequent hospital care codes, subsequent nursing facility care codes or office or other outpatient visit codes, depending on the setting. (To learn more about concurrent care coding, see "A Refresher on Medicare and Concurrent Care," FPM, November/December 2005.)

    Source: http://www.aafp.org/fpm/20070300/45aref.html

  4. #4

    Default Urgent Care and Pre-op

    There are no differences with an PCP vs an Urgent Care except for POS, and contracting issues.
    As an Urgent Care facility, we have contracts with commercial carriers that state we are only paid for specific CPT codes. However, Medicare does not have such contracting issues, and if the 4 R's are met,and the notes is documented to a LOS for consult (99241-99245), then a consult is the correct code
    With the wait time to see a Primary Care physician what they are, Urgent Cares are seeing MANY consults for Pre-op. There is no distinction on "Family Practice, Primary Care or Urgent Care when it comes to Pre-ops. Any physician can do a clearence as a consult if the criteria for a consult are met.

  5. #5

    Default Pre-op and surgeon

    I don't want to seem confrontational, but wouldn't it be in the best interest of the surgeon to have another providers opinion on whether or not a patient is well enough for surgery ???
    And what about the patients that do not have a PCP they see on a regular basis - are you maybe confusing Medicare wit a Medicare replacement plan ?

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