Coding Consult

Pre-op exams

Q: What's the correct sequencing for diagnoses associated with a preoperative exam?

A: When you submit claims for pre-op exams and diagnostic tests, list the appropriate V code (V72.81-V72.84, preoperative examinations), with the reason for the surgery as the secondary code, according to CMS' Transmittal 1719, accessible at www.cms.hhs.gov/manuals/pm_trans/R1719B3.pdf(PDF file).

For example, say an ophthalmologist requests a pre-op clearance for a hypertensive 70-year-old man scheduled for cataract surgery. You do an E&M service and order an ECG and a blood draw for various lab tests.

Report V72.83 (other specified preoperative examination) for the consultation (99241-99245, office consultation for a new or established patient), V72.81 (preoperative cardiovascular examination) for the ECG (93000, electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), and V72.83 for the blood draw (G0001, routine venipuncture for collection of specimen[s]).

Use the reason for the surgery—366.13 (anterior subcapsular polar senile cataract)—as the secondary diagnosis and assign a diagnosis for the patient's hypertension (401.1, essential hypertension; benign). Also, make sure you comply with the rules governing use of consultative codes.

Smoking counseling

Q:Will Medicare insurers pay for smoking-cessation treatments? If so, what codes and documentation should we use?

A: Medicare and many private payers will pay for smoking-cessation counseling as long as you're the one doing the counseling, not an NP, PA, or other staff member. That's because the government lists the code as a "demo project"—G9016 (smoking-cessation counseling, individual, in the absence of or in addition to any other E&M service, per session [6-10 minutes] [demo project code only]).

If you yourself counsel a patient regarding smoking, you should include this service with the E&M code.

99313 or 99302?

Q:I did a history, an evaluation, and medical decision-making on a nursing facility patient who now has pneumonia in addition to previously diagnosed influenza. The patient requires IV antibiotics and nasal oxygen. Should I report the service with 99313 or 99302?

A: Report 99302 (E&M of a new or established patient involving a nursing facility assessment, which requires these three key components: a detailed interval history, a comprehensive examination, medical decision-making of moderate to high complexity . . .) for nursing facility care if the problem resulted in a "major permanent change in status" that requires a new medical care plan.

Assign 99313 (subsequent nursing facility care, per day, for the E&M of a new or established patient, which requires at least two of these three key components: a detailed interval history, a detailed examination, medical decision-making of moderate to high complexity . . .) when the change in status is not permanent and a new medical care plan is not necessary.

Although the patient's pneumonia (487.0, influenza; with pneumonia) is serious, this condition probably wouldn't cause a permanent change in status. So the likelihood is that you'd report 99313, as long as documentation supported all three key components that the nursing facility assessment code requires.

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Coding Consult: Answers to your questions about. . ..

Medical Economics

Sep. 17, 2004;81:17.