preop exams

As an internist I don't how to code a preop exam with EKG. If someone is healthy and has no medical diagnosis other than the surgical issue what do you code?

I hate these

All you can code is v72.84- preop examination and link it to the office visit and the EKG. You can code the office visit as a consultation (if not Medicare) if the patient was sent by the surgeon to you for pre-op clearance. If it is hospital policy and no request from the surgeon, then use the regular office visit codes. Hopefully the insurer will cover this without a medical diagnosis-some see the V code and consider it a screening visit and don't pay and then you have to bill the patient.
These are frustrating since as internists we know there is little (or no) value to pre-op exams on well patients and the hospital's pre-op questions will discover any potential troubles. Pre-op exams on cataract patients really bother me- I document "the patient has a heartbeat therefore he is eligible to undergo cataract extraction."

preops

NHIC in New England told me in an email (via our Region CMS office) that if we use the V72.8X diagnosis in the first position, they will adjudicate it as "routine screening" and deny it. But, that if it was a medically necessary exam, use the patient's diagnosis code first, which is contrary to ICD-9 rules.

Since then, clients tell me that V72.8X does get paid.

Two articles:

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

http://www.codapedia.com/-article_483_.cfm

yep

I should have said that the other option is to bill the surgical diagnosis then the V72.84, such as cholelithiasis 574.21, V72.84.