Pre-Operative Clearance/Exam

Our office has always coded a Pre-op visit as, for example, 99396 with DX of V72.84. Lately we have had a lot of patients calling and saying that their insurance is telling them that it is coded wrong and that in fact it looks like a well woman or well male exam. Who is wrong is my ultimate question? The insurance company or our office? We are a family practice office and do quite a few of these a week. Thank you!!!

re: Pre-Operative Clearance/Exam

I work for a third party administrator and we would pay/or deny this claim as routine based on the CPT® code you are using. Try using a "regular" E/M code such as 99213.

re: Pre-Operative Clearance/Exam

Ok thank you

re: Pre-Operative Clearance/Exam

That is not the appropriate code for pre-op clearance. For your Medicare patients requiring pre-op clearance, you must now report an office or other outpatient evaluation and management (E/M) code (99201–99205 or, 99212–99215) . Continue to follow CPT® instructions for private patient's reporting consultation services for payers who still accept the consultation codes. Report the V72.84, also a code for medical condition requiring clearance, and 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.