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Prev-med vs E/M

  1. Default Prev-med vs E/M
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    When coding a pre-op visit in an outpatient setting, would you use a prev-me or an e.m?

  2. #2
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    Columbia, MO
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    12,572
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    within the preop timeframe I would use the surgical code plus the 56 modifier. Depending on payer outside the defined preop it is the same surgery code plus 56 or an ov code. I have a Blue Cross guide for modifiers that instructs to use the surgry code plus the 56 modifier.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
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    Are you asking from the surgeon's standpoint or from (for example) an internist who may be doing the pre-op clearance?
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  4. Default
    I work for DoD and he is the general surgeon who is doing the pre-op visit at the general surgery clinic and preforming the surgery at the local hospital.

  5. #5
    Location
    Columbia, MO
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    12,572
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    Ah! Good question Melissa! Because the answer changes everything... If theis is the surgeon doing the preop then you do not bill for it it is included in the global surgery. For DoD if you are needing to account for work units, then you should use the surgical modifiers for each portion, the 56 for the preop, the 54 for the surgery, and the 55 for the post op. I have observed it both ways in DoD. There just cannot be a separate billable charge for the preop.

    Debra A. Mitchell, MSPH, CPC-H

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