Payment for pre-operative visits require medical need

July 8, 2014

Do's and don'ts on how to receive payment for pre-operative visits.

 

Q: Our physician is a family practitioner and receives regular requests for pre-op clearances. There are times when he has questioned the need for these since the patient has no ongoing medical conditions. Is a pre-op clearance automatically paid, or does there need to be a medical reason?

A: While a surgeon’s request for your primary care provider to conduct a pre-operative clearance is usually routine, make sure there is a medical need to do so.  Medicare doesn’t consider all pre-op visits to be medically necessary.  

Focus on the word “clearance,” which means that the patient could face a different problem from the surgery if another doctor is not there to monitor those other conditions.  When nothing else needs to be monitored, nothing needs to be cleared.  

For example, Wisconsin Physician Services (WPS) has gone so far as to post a statement on its website that says that not all patients need medical clearance separate from the evaluation by the surgeon.  WPS also points out that, when it comes to Medicare, patients with comorbidities and other diagnoses who may require evaluation by someone other than the surgeon are the ones who are more likely to have medical necessity for the visit.

Answers to readers questions were provided by Renee Dowling, a billing and coding consultant with VEI Coding Consulting Services in Indianapolis, Indiana. Send your billing and coding questions to medec@advanstar.com.

 

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The answer to this reader’s question was provided by Maxine Lewis, CMM, CPC, CPC-I, CCS-P, president of Medical Coding & Reimbursement in Cincinnati, Ohio. Send your practice management questions to

medec@advanstar.com

. - See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/using-modifiers-correctly-ensure-accurate-cpt-coding#sthash.gO0Obvzv.dpuf The answer to this reader’s question was provided by Maxine Lewis, CMM, CPC, CPC-I, CCS-P, president of Medical Coding & Reimbursement in Cincinnati, Ohio. Send your practice management questions to

medec@advanstar.com

. - See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/using-modifiers-correctly-ensure-accurate-cpt-coding#sthash.gO0Obvzv.dpuf The answer to this reader’s question was provided by Maxine Lewis, CMM, CPC, CPC-I, CCS-P, president of Medical Coding & Reimbursement in Cincinnati, Ohio. Send your practice management questions to

medec@advanstar.com

. - See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/using-modifiers-correctly-ensure-accurate-cpt-coding#sthash.gO0Obvzv.dpuf Answers to readers' questions were provided by Renee Dowling, a billing and coding consultant with VEI Consulting Services in Indianapolis, Indiana. Send your billing and coding questions to

medec@advanstar.com

.  - See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/how-ensure-accurate-billing-durable-medical-equipment-orders?page=0,1#sthash.MvuZr8Vi.dpuf Answers to readers' questions were provided by Renee Dowling, a billing and coding consultant with VEI Consulting Services in Indianapolis, Indiana. Send your billing and coding questions to

medec@advanstar.com

.  - See more at: http://medicaleconomics.modernmedicine.com/medical-economics/news/how-ensure-accurate-billing-durable-medical-equipment-orders?page=0,1#sthash.MvuZr8Vi.dpuf