Pre-op clearance

[jcbilling]

I'm billing for a family physician that is doing pre-op clearance for hand surgery.

There is an office visit, xray, and EKG. Are the procedures billed a different way for pre-op?

This is how I was going to bill it.

99214 -25
93000
71020

Also, would the -51 modifier be necessary on the second procedure?

Thanks in advance,
Charity

[Michele]

You really don't need any modifiers in the situation you describe.  The 99214 would not be bundled with the ekg or the xray.

However, I hate to confuse things, but pre-op clearances are actually supposed to be billed using the surgical code (for the procedure they are going to have) with a 56 modifier.

Modifier 56 - Preoperative Management Only: When one physician performed the preoperative care and evaluation and another physician performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number.

Michele

[jcbilling]

When you say "surgical code", do you mean a different cpt code for the procedures?

~ Charity

[Michele]

Yes, the cpt code for the surgery they are planning on having.

Michele

[jcbilling]

Sorry for my ignorance, Michele! I'm trying to learn how do this correctly and sometimes my brain doesn't get it!!

If I'm understanding you correctly, I would bill the surgical code with a -56 modifier for the physicain that is doing the pre-op clearance. Would I include the procedures that were done for pre-op clearance or just bill the one surgical code and that would include all the pre-op clearance procedures?

~ Charity