Codapedia is now a division of Find-A-Code

Pre-op visits: True or False?

December 29th, 2015 - Codapedia Editor
Categories:   Coding   Compliance   Evaluation & Management (E/M)   Modifiers   Surgical Billing & Coding  
0 Votes - Sign in to vote or comment.

Are the following statements true or false?

• The PCP cannot be paid to do a pre-op assessment of a Medicare patient prior to surgery because of the new consult rules.

• The surgeon can never be paid to do a pre-op visit if s/he is going to take the patient to surgery.

• The surgeon can bill and be paid for an office visit for the purposes of a pre-op H&P after the decision for surgery is made, but before the surgery itself, if the hospital requires it.

All of these statements are false!

Let’s take them one by one:

      The PCP cannot be paid to do a pre-op assessment of a Medicare patient prior to surgery because of the new consult rules.

This is false. The primary care provider may be paid to do a medically necessary pre-operative assessment on a Medicare patient prior to surgery, but the visit is billed with a new or established patient visit code. For that matter, a cardiologist or pulmonologist can also bill for these services. The important thing: the visits must be medically necessary for the patient. Routine or screening services are not payable.

     The surgeon can never be paid to do a pre-op visit if s/he is going to take the patient to surgery.

This is false. The global surgical payment does include payment for pre-operative services, intra-operative service and post-operative care. The Medicare Fee Schedule includes the percentages for each component for each surgical CPT® code. The pre-operative care is roughly 10%, depending on the service.

When can the surgeon be paid for a pre-op visit?

• For the evaluation of the problem, if the procedure is not done that day or the next day.

• For the evaluation of the problem, if it is a minor procedure with a zero or ten day global period, when the Evaluation and Management service is a significant, separately identifiable service, meeting the criteria for using modifier 25. For example, a gynecologist is asked to see a patient with abnormal bleeding, and decides to do an endometrial biopsy on the same day. Both services may be reported and should be paid.

• For the evaluation of a problem, if it is a major procedure with a 90 day global period, and the physician decides at that visit to take the patient to surgery that day or the next day. If the visit meets the requirements for the use of modifier 57, it is a separately reportable (and payable) service.

There are articles in Codapedia about the use modifier 25 and modifier 57.

        The surgeon can bill and be paid for an office visit for the purposes of a pre-op H&P after the decision for surgery is made, but before the surgery itself, if the hospital requires it.

This is false. Some surgeons believe they can bill for a visit after the decision for surgery was made and before the surgery for the purpose of the H&P, completing the consent forms and educating the patients about what to expect. This is not a separately payable service and should not be billed.

The CPT® Assistant in May of 2009 answered this question specifically. Here is a quote from their newsletter:  

 If the surgeon sees a patient and makes a decision for surgery and then the patient returns for a visit where the intent of the visit is the preoperative H&P, and this service occurs in the interval between the decision-making visit and the day of surgery, regardless of when the visit occurs (1 day, 3 days, or 2 weeks), the visit is not separately billable as it is included in the surgical package.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

HHS Proposes Significant Changes to Patient Access Rules
February 11th, 2019 - Wyn Staheli, Director of Research
In a significant announcement on February 11, 2019, HHS proposed new rules aimed at improving interoperability of electronic health information. This announcement was made in support of the MyHealthEData initiative which was announced by the Trump administration on March 6, 2018. The goal of that initiative was to break down ...
Charging Missed Appointment Fees for Medicare Patients
February 7th, 2019 - Wyn Staheli, Director of Research
Some providers mistakenly think that they cannot bill a missed appointment fee for Medicare beneficiaries. You can, but Medicare has specific rules that must be followed. These rules are outlined in the Medicare Claims Policy Manual, Chapter 1, Section 30.3.13. You must have an official “Missed Appointment Policy” which is ...
Q/A: Do Digital X-rays Have Their Own Codes?
February 7th, 2019 - Wyn Staheli, Director of Research
Question Are you aware if digital x-ray of the spine requires a different code than plain x-ray? If so, where can I find the information specific to digital x-ray codes? Answer There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual ...
Clinical Staff vs Healthcare Professional
February 5th, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals.  Physician or other qualified healthcare professionals:  Must have a State license, education training showing qualifications as well as facility privileges.  Examples of Qualified Healthcare professionals: (NOTE: this list is not all-inclusive, please refer to your payer ...
BC Advantage Now Offering Q-Pro CEUs!
February 5th, 2019 - Find-A-Code
We are excited to announce BC Advantage is now offering Q-Pro CEUs! It is now even easier to get your QPro CEUs and stay current with BC Advantage: offering news, CEUs, webinars and more. BC Advantage is the largest independent resource provider in the industry for Medical Coders, Medical Billers,...
Attestations Teaching Physicians vs Split Shared Visits
February 1st, 2019 - BC Advantage
Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ...
Q/A: Can I Bill a Review of X-Rays?
February 1st, 2019 - Wyn Staheli, Director of Research & Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
It is not unusual for a healthcare provider to review x-rays taken and professionally read by another entity. Questions arise regarding how to bill this second review. It is essential to keep in mind that the global (complete) service of taking an x-ray is composed of both a professional and ...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association