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Pediatric Coding Alert

Reader Questions:

Use 99241-99245 When Preoperative Meets 3 Criteria

Question: What is the CPT code for a pre-op exam?

New Jersey Subscriber Answer: No CPT code exists specifically for a preoperative examination. Pediatricians typically perform preoperative exams for surgical clearance requested by a surgeon -- a scenario that typically falls under a consultation (99241-99245, Office consultation for a new or established patient ...). But if the encounter does not qualify as a consultation, you should instead report an office visit (99201-99215, Office or other outpatient visit ...). Here's how to choose the correct E/M service code set:
Use a consultation code when 1) another professional requests the consult, 2) the pediatrician renders her opinion and 3) she sends a report to the requesting source. Documentation in the chart should clearly support these consultation requirements. For instance, if a dentist requests your opinion on a patient's ability to withstand anesthesia, assign 99241-99245 with ICD-9 codes that indicate any underlying condition, the type of preoperative exam (V72.81-V72.84) and the reason for surgery.
When the E/M service does not meet the above consultation requirements, you should instead assign an office visit code (such as 99212-99214).  -- Answers to You Be the Coder and Reader Questions answered/reviewed by Peter Rappo, MD, FAAP, a practicing pediatrician and clinical professor of pediatrics at Harvard Medicine School in Boston; Charles Scott, MD, FAAP, a pediatric coding expert who practices with Medford Pediatric & Adolescent Medicine in New Jersey; Richard H. Tuck, MD, FAAP, a national pediatric coding speaker and educator.