Monday, December 20, 2010

Truth about pre op visit - PCP will get pay?

Pre-op visits: True or False?

Are the following statements true or false?

• The PCP cannot be paid to do a pre-op assessment of a Medicare patient prior to surgery because of the new consult rules.
• The surgeon can never be paid to do a pre-op visit if s/he is going to take the patient to surgery.
• The surgeon can bill and be paid for an office visit for the purposes of a pre-op H&P after the decision for surgery is made, but before the surgery itself, if the hospital requires it.



All of these statements are false!

Let’s take them one by one:

      The PCP cannot be paid to do a pre-op assessment of a Medicare patient prior to surgery because of the new consult rules.

This is false. The primary care provider may be paid to do a medically necessary pre-operative assessment on a Medicare patient prior to surgery, but the visit is billed with a new or established patient visit code. For that matter, a cardiologist or pulmonologist can also bill for these services. The important thing: the visits must be medically necessary for the patient. Routine or screening services are not payable.

     The surgeon can never be paid to do a pre-op visit if s/he is going to take the patient to surgery.

This is false. The global surgical payment does include payment for pre-operative services, intra-operative service and post-operative care. The Medicare Fee Schedule includes the percentages for each component for each surgical CPT® code. The pre-operative care is roughly 10%, depending on the service.

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