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Coding for Pre-Op Clearance

  1. #1
    Albuquerque, NM
    Question Coding for Pre-Op Clearance
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    I recently took on doing pre-op clearance coding for a Joint Program that does orthopedics, one doctor does the pre-op clearance, another does the procedure, and then either the doctor that did the procedure does the post-op. I attended a webinar and found out that to bill for the pre-op I should be billing the procedure with Modifier 56, the procedcure with modifier 54 and the post-op with modifier 55, and each provider will get a portion of the reimbursement. The webinar host stated this is the most miss coded of all she has audited...anyone provider for the pre-ops states I should be doing the office visits????

  2. #2
    Columbia, MO
    I agree with the use of the 56 modifier. This is the purpose of this modifier.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Albuquerque, NM
    Thumbs up
    Thank you Debra that is the confirmation I needed.

  4. #4
    Milwaukee WI
    Default WAIT a minute
    Maybe I am misreading your original post. Are all these doctors part of the same practice and same specialty? If so, then NO you cannot unbundle the service. It should be coded just once by the surgeon performing the procedure. For billing purposes physicians of the same specialty in the same practice are considered the "same physician."

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  5. #5
    Columbia, MO
    good point Tessa, I interpreted as physicians in different practices.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Hello Tessa and Debra

    Is it Ok to code with E/M code along with the Pre=op diagnosis. Ex: patient is going for cataract surgery. Can I code 366.9 (cataract) with 92012 for Opth

    Thank U

  7. #7
    Albuquerque, NM
    Default Denials
    Well, I have tried the procedure and the modifier 56 and getting denials, the provider is family practice, and not part of the group....In the beginning I was billing E&M with the dx such as 715.36 getting paid, now I am billing 27447 56 RT and getting denials stating charges are for a procedure that can only be performed in an inpatient facility....

    Now I am really confused.....any more clues????

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