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Preoperative visit CONFUSION

  1. #1
    Unhappy Preoperative visit CONFUSION
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    I am soo confused after reviewing a multitude of posts on preop visits. Please help!!

    First, I code for OBGYN and ORTHO, both do their own preoperative exams for the most part. They are performing these days to weeks prior to surgery, (not the previous/same day). I have read conflicting things, some say this is still considered part of the global regardless of how soon prior to surgery the service occured, others state it can be billed since it is not the day of or immediately prior to surgery.

    Second, I also code for family practice (small rural area/almost all hospital owned), the PCPs are also requested by the general surgeon to perform a preop exam on patients when they have other conditions, such as, hypertension and diabetes, etc.. Now, since the request is specifically because of the patients conditions and not just a preop is this an E&M or do I bill the surgery with a 56 modifier. (Which I never knew should have been done!!) An added question to this preop: How do I know for sure the correct procedure code to bill with a 56?

    I'm so confused and frustrated!


  2. Default
    As far as pre-op clearance and mod -56, below is the Q&A I submitted to another source. For me, I will continue to code pre-op clearance just as I always have (E&M w/ V72.83 etc) until specific guidance on having to code the surgical CPT with mod -56 is issued in writing.

    Question: Information is being put out there that all pre-ops must be coded with the surgical CPT code and mod -56 and if not it is double billing for the pre-op portion of the RVU. Here is the scenario. Please advise on how the FP encounter is coded:

    FP sees patient several times and then refers the pt to an Ortho specialist for treatment. That was 6 months ago and the FP has not seen the patient since making the referral. Now, Ortho specialist has sent the patient back to FP for a pre-op clearance for a total knee replacement due to pt's HTN. FP does full exam and EKG and clears patient for surgery. Patient returns to Ortho specialist and surgery is done 4 days after pre-op.

    Does FP code this preop clearance visit as 9921x? OR Does FP's office call the surgeon's office after the surgery, confirm the surgical CPT the surgeon's office is coding/billing (and that they are also submitting with mod -54 and -55) and then submit the preop clearance service with the Surg CPT with mod -56?

    Response: This should be coded as an estabished patient outpatient visist, 9921X.
    Last edited by sbicknell; 09-14-2010 at 07:55 PM.

  3. #3
    Thanks so much for your reply. This is the way we have been billing in the past, and we will continue to do so as well. It's nice to know others have similar situations. I had never before ran across any documentation that stated an H&P by primary physician should be billed with the procedure code and modifier 56, until I happened upon the posts. Needless to say I was in a slight panic. However, as stated our primary docs are normally requested to perform these on patients who are high risk due to medical conditions being treated by the primary.

    Thanks again!


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