RE: Pre-op clearance abuse

[Guest guest]

As many know, a Preop Clearance can be coded as a Consult (even if it is a regular patient you follow) visit if the surgeon sends a request for a Preop Evaluation.If the surgeon doesn't request a consultative visit cannot be coded.

Below is a letter someone posted to the list in the past -- apologies if whoever designed it didn't wanted it spread around.

Might be useful for some docs.

Referral Worksheet for Pre-Operative Medical Evaluation and Optimization for Surgery

Fax completed and signed form to xxx-xxx-xxxx

Patient Name: ____________________________________________________________________

Proposed Surgery/Procedure: _______________________________________________________

Reason for Medical Consultation (Medical Diagnoses): __________________________________

Date of Surgery/Procedure: ____________

“I request that Dr. X provide medical consultation for the above patient to evaluate peri-operative risks and to optimize medical condition prior to surgery.”

____________________________ _________________

Requesting physician’s signature UPIN#

Dear Doctor,

Re: Preoperative history and physical/surgical “clearance”

Although we appreciate being “in the loop” of our patients’ surgical care, according to CPT, a preoperative history and physical examination are part of the global fee for services included in the surgical procedure. As such, for us to complete this paperwork is not a covered benefit by the patient’s medical insurance, and we will not be paid for this service.

If the surgeon feels that the patient has a medical problem that may cause the patient to be at increased risk for the planned surgery, the surgeon may request a medical consultation in writing. With this consultation, Dr. X will order and/or recommend appropriate diagnostic studies and make suggestions as to medications peri-operatively. Dr. X cannot “medically clear” a patient for surgery, but can help to determine the patient’s relative risk of surgery. It is the surgeon’s responsibility (with the input of the patient) to determine whether or not the patient should undergo any particular surgical procedure. Also, this consultation is still not truly an admission history and physical, and might not be considered as such by the hospital or surgery center being used.

If a surgeon insists upon Dr. X performing a history and physical prior to surgery, or requests a consultation for which there is no active or significant-to-surgery medical problem, the patient may be entirely responsible for the cost of the visit and any tests.

http://www.fpnotebook.com/Manage/Billing/EmCnsltnSrvcs.htm

Indication

Outpatient Consultation

Outpatient Consultation: CPT Code 99241

Key Components (All 3 meet or exceed requirements)

E/M Problem Focused History

E/M Problem Focused Exam

E/M Straightforward Medical Decision

E/M Self Limited or Minor Problem

Physician Time: 15 minutes

Established Outpatient: CPT Code 99242

Key Components (All 3 meet or exceed requirements)

E/M Expanded Problem Focused History

E/M Expanded Problem Focused Exam

E/M Straightforward Medical Decision

E/M Low Severity Problem

Physician Time: 30 minutes

Outpatient Consultation: CPT Code 99243

Key Components (All 3 meet or exceed requirements)

E/M Detailed History

E/M Detailed Exam

E/M Low Complexity Medical Decision

E/M Moderate Severity Problem

Physician Time: 40 minutes

Outpatient Consultation: CPT Code 99244

Key Components (All 3 meet or exceed requirements)

E/M Comprehensive History

E/M Comprehensive Exam

E/M Moderate Complexity Medical Decision

Problem Severity

E/M Moderate Severity Problem

E/M High Severity Problem

Physician Time: 60 minutes

Outpatient Consultation: CPT Code 99245

Key Components (All 3 meet or exceed requirements)

E/M Comprehensive History

E/M Comprehensive Exam

E/M High Complexity Medical Decision

Problem Severity

E/M Moderate Severity Problem

E/M High Severity Problem

Physician Time: 80 minutes

Locke, MD

From: [mailto: ] On Behalf Of Jacques GuillotSent: Sunday, January 20, 2008 2:01 PMTo: IMP message list serverSubject: Pre-op clearance abuse

Here is a letter I've only had the nerve to send once or twice, but I should use routinely:TO: SurgeonsRE: Medical clearanceDear Colleague:If you need clearance for a procedure, please send me a written request for consultation. Please indicate diagnosis, planned procedure, location, and date. If there are any specific issues or questions based on the patient's acute problem or chronic conditions, please be clear so I can address them. I cannot give clearance based on labs, EKGs, or other ancillary testing. There can be an exception to this only if I have seen the patient in the immediate recent past. It might be up to you to determine whether there are acute symptoms requiring formal clearance or pre-operative medical evaluation. I will prepare my thorough report and return it to you with my assessment and recommendations. I will not fill out forms or H & P documents, especially for facilities at which I am not on staff. If necessary, you can have a clerk transcribe information from my notes to any necessary forms. Feel free to call me if we need to discuss the case.

[Guest guest]

Well done and thanks. Jacques Guillot, MD._,___

[Guest guest]

This a concern for everyone. I have a couple of questions after reviewing your thoughts. 1. should we not fill the preop form to some hospital u are not staff at 2.Do u fill the preop history form because we are the primary care MD 3. Do u give recommendation on the form for the medical issues patient has that has to be watched (periop- eg nitro, beta blocker etc.) Thanks to all Have a happy Monday MT

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