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Pre-Op exams

  1. #1
    Default Pre-Op exams
    Medical Coding Books
    I need some clarification on how to properly code pre-op exams! One of my providers does pre-op dental exams for Medicaid patients. He has been coding these as wellness exams. He claims he is doing full physical which supports his coding choice. Now, Medicaid only covers one wellness/year. We have patients that have came in for their annual wellness, then months later it is discovered that they need dental surgery. Since Medicaid won't pay for a second WCC, how should this be coded? I have found mixed answers. I have found that most people say to use a E/M sick visit code (99201-99215), with the V72.83 as a primary dx. But, technically this wouldn't be a sick visit.

    Can anybody give some insight on how to correctly bill for a pre-op exam?? Thanks!!!

  2. Default
    I am almost positive it is bundled into the operation. In General Surgery all of the pre op histories and physicals are part of the global package if done within 24 hours of the operation, a good source is the medicare website.

  3. #3
    We aren't the performing the surgery. We are just the patient's PCP that the surgeon is requesting a clearance from.

  4. #4
    Post Pre-Op Exam
    I would rather go with E/M F/U visit codes (99211-99215) with V72.83, as you are working for PCP and he/she would obviously be doing a f/u for this patient w/ or w/o a disease or S&S.

    Though on the other thought, I am wondering why would PCP do a pre-op of the patient, it is usually done by a specialist. PCP's do refer patients for a disease and thereby a decision for surgery and the need to do pre-op exam. All replies to increase my knowledge in this regard are welcome.
    Girish Dadhich, CPC

  5. #5
    Lynchburg, Virginia
    Default Pre-Op Exam
    We just had this discussion the other day in another section. If the surgeon is requesting an examination for clearance for surgery from the PCP, then the PCP can bill a consult. But the surgeon has to request those services by letter to provide supporting documentation for the consult. Otherwise, just bill 99211-99215. Either way, you should use the V72.83 for your dx.

    In the other discussion, we clarified the term "pre-operative exam". That is done by the surgeon. Clearance for surgery is done by a specialist or PCP. I bill for primary care providers as well and we do clearance exams all the time.

    Janice Brashear, CPC
    Last edited by jbrashear; 05-26-2011 at 01:56 PM. Reason: to add detail

  6. #6
    FWIW, I second Janice's post. That's what we do.

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