pre op visits

MD saw pt June 22 & billed 99215. Reason for visit was left ovarian cyst Comorbidities discussed with pt. MD ordered lab & US. Pelviscopy &BSO are scheduled. Documented that pt will not need medical clearance. Pt was to return to office to have preventive visit & PAP. (Diagnoses on claim include pre-op exam for gyn surgery & left ovarian cyst)

June 24-has annual exam performed & billed

July 8-billed 99215. Saw pt to review US & counseled re surgery & consent obtained. (diagnoses on claim include left ovarian cyst & pre-op exam for gyn surgery)

July 29-surgery done

Question-Can we bill for the July 8 visit? We weren't sure if the decision for surgery was 6/22 & not billable. OR if the decision for surgery was 7/8.




  • edited May 2017
    As far as I am concerned Pelviscopy and BSO scheduled should be your first clue as to when decision for surgery was performed. I would not bill the July visit.

    Sent from my iPhone

  • edited May 2017
    I keep the ability or non-ability to bill to bill pre-op visits within the global surgery guidelines.

    Although the patient came to the physician with an ovarian cyst, it doesn't mean it will require surgery, it will be pending results of the diagnostic findings. The physician has the right medically to discuss findings with the patient and make decisions in regards to upcoming surgery (hence modifier -57 when within 24 hours of surgery). The patient also has the choice to decide if they want the surgery or not.

    The patient can also have a medical event in the 21 days prior to the surgery performed. Terminology in records stating 'no pre-op clearance needed' may or may not fit the hospital / outpatient facility's requirement for anesthesia, that is determined by their protocol.

    I would recommend billing for the July 8th visit as long as there are no written guidelines in the practice, such as 'all pre-op visits are 3 weeks in advance' - which would scream bucking the system to an auditor. My rationale is that the clinical findings of the test(s) performed (being +) would require medical decision making by the physician and he/she would have the right to be paid, outside of global surgery payment.

    Karen Hurley, BS, CMM, CPC, CNA
    President, HPMSI
    PO Box 409
    Parrish, FL 34219-0409
    Tel: (941) 776-4822
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