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Pre-op Exam with EKGs and Labs

  1. #1
    Default Pre-op Exam with EKGs and Labs
    Medical Coding Books
    I had a post asking about how to properly code a pre-op exam (clearance) from a pcp provider, and it seems that you code the surgical CPT code with a modifer 56. What do you do if the surgeon is requesting labs and an EKG to be done? As the PCP, are we to be doing those tests in the office, or does the patient need to go to an outside lab or hospital lab as the surgeon being the ordering doctor. IF the PCP provider is suppose to do the EKG along with any labs... are these charges all included in the global fee of the surgery, or will there be the surgery code along with the certain labs and EKG fees? If I can get some guidance, that would be great; thank you !!

  2. #2
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    Quote Originally Posted by kcaskey03 View Post
    I had a post asking about how to properly code a pre-op exam (clearance) from a pcp provider, and it seems that you code the surgical CPT code with a modifer 56. What do you do if the surgeon is requesting labs and an EKG to be done? As the PCP, are we to be doing those tests in the office, or does the patient need to go to an outside lab or hospital lab as the surgeon being the ordering doctor. IF the PCP provider is suppose to do the EKG along with any labs... are these charges all included in the global fee of the surgery, or will there be the surgery code along with the certain labs and EKG fees? If I can get some guidance, that would be great; thank you !!
    As the PCP you do not code the surgical code with modifier 56. You are only providing surgical clearance not doing all the pre-op work for the procedure, so the PCP bills an E/M code with the V72.8x code that applies. The surgeon can request the labs and EKG so that they get the results back to them, unless your provider needs the results of those tests in order to clear the patient for surgery. The labs and EKG are separately billed by whatever provider does the testing and interpretations.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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