pre op eaxm

I work for a Nephrology group and we sometimes are ask to perform a pre op eaxm. What code could i use and what documentation will suport it?

pre op exam

Documentation must support medical necessity based on risk factors which may affect anesthesia or the surgical procedure. The appropriate V code for pre-op exam is coded first as well as the condition requiring the procedure and any conditions that may impact the procedure risk (example, V72.83 (other specified preop exam)
The acute or chronic medical condition for which the patient requires surgery should be listed as the secondary ICD-9-CM code. (3) Additional codes may be used for the patient's other acute or chronic medical conditions.

pre op exam

Here's an article about the topic.

http://www.codapedia.com/~article_58_.cfm

Don't forget...

"Dr Y referred Mr. X for pre-op eval" and "thank you for referring patient; copy of this report sent to Dr Y"

Pre-op

Preoperative work is performed by the surgeon. If the surgeon cannot perform that part of the service, and needs to defer to another provider (PCP or specialist), they would request it specifically and the reason for such intervention. You would code the E/M service with ICD-9's that are specific to the reason the patient is being seen (usually the condition the surgeon can't clear) - and then use the V code last for notation of preoperative service. This would be the most accurate way to report preoperative intervention.

Betsy- what do you think of that answer???

We need a Bobbie Flay Smackdown on how you code a pre-op consultation. I have heard lots of options.

Take a cataract patient sent to primary care for clearance who has Diabetes and hypertension.
Do you code in which order?
366.10, V72.84, 250.00, 401.1 OR
V72.84, 366.10, 250.00, 401.1 OR
250.00, 401.1 366.10 V72.84

pre-op

option 2 if the payor accepts V code as primary--which is the reason for the encounter.

official coding guidelines

Official coding guidelines: "For patients receiving preoperative services only, sequence first a code from category V72.8, Other specified examinations, to describe the pre-op consultations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Code also any findings related to the pre-op evaluation."

Pre op diagnosis codes

If you follow ICD-9 coding rules, then the V72.8X codes should be listed first. However, if you list one of those codes first, most payers, including Medicare DENY them.

One of my clients was submitting this way, and appealing each one, which they won.

I queried someone at CMS in my region, who passed the question along to NHIC, which was the carrier, is the MAC for New England. This is what they said:

Use the V code first if the visit is ROUTINE and non-covered, because routine, and we will deny it.

Use the medical diagnosis code first if the visit is MEDICALLY NECESSARY and we will pay it.

Totally against ICD-9 rules. NHIC sent that in an email to my CMS contact, who forwarded it to me. I pass that very information along to clients. I know that what Nancy says is true, from a coding perspective, and I never want to disagree with Nancy. But, I tell my clients: if it is a medically necessary service, don't but the V72.8X in the first position, unless you want to take the time to appeal the denial.

Exactly!

If the reason is only pre-op, then that code would be first. If the surgeon could not clear the patient for surgery because of some medical reason and needed the assistance of another physician to do it - the reason for the pre-op clearance is coded first - i.e. the medical condition that kept the surgeon from clearing the patient in the first place. No plan will pay for the medical decision making to perform the surgery on a patient twice unless there is a medical reason to do so.

Pre-op exams

Karen and I have seen too many of these denied, with the V code first, when there was medical necessity. I don't want to speak for her, but I know that ICD-9 guidelines say to put it first.

Here's what I have from a policy staff person at a carrier office:

The provider is not the surgeon, therefore, I am assuming perhaps the
>provider is the patient's regular MD. If the physician is performing a MEDICALLY NECESSARY pre-operative visit (because the patient has an underlying medical condition which may
affect the surgery or which may prevent them from being able to be under
anesthesia for the surgery) the physician should bill the exam with the diagnosis for that condition.
>
>If the patient is in good health and the surgeon wants their regular MD (or another MD) to do an exam to make sure they are still in good health and would be able to withstand the surgical procedure, the V diagnosis code should be used as primary and the claims would then be denied as routine because there technically is no medical reason for the exam.

Of course, I know that a private email doesn't change policy, but this is what I say to do.

pre-op visit

thank you everyone for your honesty on this topic! The line between reality and rules/regs has become difficult to distinguish at times. I feel like I cannot give advice without the specific "proof" from a reliable source. What happened to common sense?

DIRECT FROM CMS via WPS!!! V code first!!!!!!!!

Billing for Preoperative Examinations

List the appropriate ICD-9 code for the preoperative examination (V72.81 through V72.84). List in item 21 position 1. This is your primary diagnosis.
If available, list the ICD-9 codes for the condition(s) that prompted surgery and for conditions that prompted the preoperative medical evaluation (if any). List in item 21 position 2-4.
The ICD-9 code referenced in item 24e must be the primary reason for the preoperative examination.

from: http://www.wpsmedicare.com/part_b/education/2009_0622_physervcoding.shtml

This is correct.......

[Official coding guidelines: "For patients receiving preoperative services only, sequence first a code from category V72.8, Other specified examinations, to describe the pre-op consultations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Code also any findings related to the pre-op evaluation."]

If the service is PREOPERATIVE ONLY (just for 'clearance') there is no separate payment made by a plan for this, nor for the reason for the surgery. The surgeon is paid to know if his patient can have the procedure. Now, if the patient has a condition that keeps the surgeon from 'clearing' them.......and they need the assistance of another provider to do it - the accepting provider would code the diagnosis they are seeing the patient for (HTN, DM, etc). We get way too caught up in the hospital's requirement for 'pre-op' and the surgeon deferring that to someone else - when they are paid to do it for their patient. If they can't, per their medical judgement, then the reason for that service is not the diagnosis for surgery but the health problem that warranted the additional service.