Proper coding format and establishing medical necessity are key.
Preoperative consultations are services needed to ensure the patient can medically withstand surgery and the use of anesthesia. Coding requirements for preoperative consultations are used so that the internist's office performing the visit will be properly reimbursed. Close attention to detail and knowing the correct coding formats will ensure successful submission with the insurance company. Establishing medical necessity is the key to being reimbursed for preoperative consultations with the proper diagnosis code.
Establishing Medical Necessity
To establish a medical necessity, a chronic illness must be identified. Conditions such as diabetes, high blood pressure or breathing trouble are good examples, because they may pose a risk to the patient when under anesthesia. When a chronic illness is presented, the internist's expert opinion is required to ensure the patient will remain in stable condition during surgery.
Using the Proper Consultation Code
Preoperative examinations for new or established patient in office are coded as 99241-99245. If the patient is seen in the hospital, the coding is 99251-99255. If the surgeon performing the operation requests the internist to serve as the follow-up physician, an established patient office code should be reported.
Proper Diagnosis Codes
Reporting the correct diagnosis code (ICD-9) with the consultation code is the most important aspect of being reimbursed by the insurance company. A "V" code should never be used for establishing chronic illness. V codes would be used only if no underlying condition is present, as a secondary diagnosis code. Matching the diagnosis code to the chronic illness is crucial. The diagnosis code should also not be presented as the reason for surgery. Code V72.81 is used for patients with a cardiovascular condition; V72.82 is used for respiratory illnesses. Code V72.83 should be used for all other chronic conditions. Should the patient have no underlying illnesses, code V72.84 would be used. Claims presented with code V72.84 will not be reimbursed by insurance because no chronic condition was present.
