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.
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