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Preoperative clearance and preoperative Duplex Ultrasound


our office performs outpatient surgery for varicose veins -we were advised that our anesthesiologist could bill for preoperative clearance under CPT 99215 and preoperative Duplex Ultrasound CPT 93971.This information was given to us by another medical practice that also performs surgery in the office - unfortunately, most of the insurance co's have denied these two because they are not considered separate and billable. Our anesthesiologist also performs Monitored Anesthesia Care CPT 01260 and to provide preoperative clearance should be a separate situation, is this not true? We could also use another E/M code  99214 Also, depending on the insurance co, we use pos 11 or 24 so Im not clear as to the pos for the E/M and Ultrasound either.

I thought pre-op clearance was done by the patient's PCP?  I have not heard of it being done by the anesthesiologist.  Is this an actual pre-op exam?  Or is it the anesthesiologist interviewing the patient prior to surgery?

If it is the actual pre-op exam that is usually performed by the PCP then it is billable and is usually covered by insurance if coded properly.  Most insurances want them billed using E&M codes (99201-99215) with the dx code for the reason the patient is having the surgery as the primary dx.  For example if a patient is going in for hip replacement surgery due to a fracture, the primary dx for the pre-op exam is fractured hip.

If this is for the anesthesiologist interviewing the patient prior to surgery, it can be billed but I am not sure that is covered.  I think that is considered part of the procedure.

thanks for your reply - the Anesthesiologist performs a preoperative evaluation, in addition to the anesthesia record and recovery room admission. This is also a requirement for our accreditation. The surgeon also performs a preoperative clearance which is included in his surgery fee. We had been advised by other anesthesiologists that they are reimbursed separately for their pre-op workup.

I'm not sure how they are billing it.  I would see if they would share what CPT code they use to bill.  Maybe an E&M?


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