Forum - Questions & Answers

May 27th, 2015 - krmm00

pre-ops and office visits

Our providers have been billing an E/M for their pre-ops and also an E/M for an office visit of another medical condition. We have tried to explain that we cannot bill 2 E/M's on the same date of service and it should all be included in the pre-op visit. Can anyone help me with finding information on this to provide to them, or if we are not correct, please provide information on this as well?

May 27th, 2015 -

re: pre-ops and office visits

per the Coders Handbook by the Practice Management Information Corporation, 2015 it states; Rules governing the reporting of more than one E&M code for a patient on the same date of service are very complex, However the NCCI(National Correct Coding Institute)contains numerous edits based on several principles including, but not limited to:

1. A physician may report only one"new patient" code on a single date of service.

2. A physician may report only one code from a range of codes describing a initital or established E&M service on a single date of service.

If your provider is seeing the patient for other medical conditions during the preop then that would constitute a higher level of E&M as long as the documentation supports it, but you absolutely cannot bill for two E&M services during one visit. This would be considered fraud.

Also just an FYI, the preop is considered part of the CPT® surgical package, found on page 49 in the 2015 CPT® standard edition an evaluation and management subsequent to the decision for surgery on the day berfore and/or day of surgery including history and physicial is included.



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