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Jamie Posted Fri 09th of February, 2018 14:08:18 PM
Confusion...wanting to make sure I am billing this appropriately. Example: Pt scheduled for a Pre-op w/Pre-op ppwrk from ref doctor CC - Pt here for pre op px HPI - Patient's here for pre-op Physical in addition to just a regular physical(This is all it says) Exam - Comprehensive exam done MDM - Will call with results and fax package to Dr. XXX.) ICD Codes (I10, M25.569, R73.03, Z00.00, G47.30) For optimal healing postoperatively I recommend daily 5000 units of vitamin D3 as well as 1000 mg of vitamin C. Consider the Resmed air mni Cleared for general surgery pending lab results. additional text added: Labs back- normal EKG - possible old MI. Not clinically applicable. Cleared for Surgery. Provider is charging patient for a Preventative Exam for the above example. Are providers like to bill a preventative exam as the exam portion is covered by insurance at 100% but looking at the visit as a whole it would be more appropriate to code a pre-op consult. Can you please advise what the correct billing is for this situation as this is coming up more frequently. Thank you so much for your help on this one.
SuperCoder Answered Mon 12th of February, 2018 05:41:12 AM

Hi Jamie,

Coding preventive exam with preoperative visit is bit tricky and may require some stick documentations and payer decision. Please see different scenarios to get these services paid.

1: In the above documentation it seems Family physician is doing this service at the request of a surgeon, who is usually seeking the family physician’s opinion on whether the patient is fit for surgery, you should be able to report these preoperative visits using a consultation code. If the service is done in the office, use an office consultation code (99241–99245); if it is provided in the hospital, use an initial inpatient consultation code (99251–99255); (otherwise, preop evaluation is considered to be part of global day package, which is not billed separately).

Also, above documentation does not clearly indicate patient was scheduled for preventive exam, so we will not bill preventive exam with this limited information.

2: Medicare does not pay for the preventive services.

Please feel free to ask for any further query.

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