Legal Tips
Provided by Carolyn Buppert, MSN, JD, ANP

Billing Medicare for a preoperative evaluation.

NPs are asking whether they can bill Medicare for a preoperative evaluation. The answer is--Not as a separate charge. Medicare considers the preoperative evaluation to be a part of the anesthesiologist's work, and pays for it in the global anesthesia charge.

If a patient comes to a primary care practice for a preoperative evaluation, and the patient has a medical diagnosis and treatment is given, then the practice can bill the visit under the appropriate ICD-9 and CPT codes for the medical diagnosis, and also include the V-code for preoperative evaluation.

If a patient is perfectly healthy and does not have a medical diagnosis under which the office visit can be billed, then Medicare will not pay the primary care provider for the preoperative evaluation. (Because it is paid for under the anesthesiologist's fee.)

This rule backs the NP into a corner, because the NP may not know, prior to doing the evaluation, whether or not there will be a medical diagnosis under which the visit can be billed. The best practice for an NP is to tell the patient--before the evaluation-- that the patient MAY be responsible for the bill.

It may save time to prepare a short written explanation for patients, which the receptionist can read patients calling for an appointment for preoperative evaluation.

This tip is excerpted from The Green Sheet, a monthly newsletter on NP reimbursement and compensation from the Law Office of Carolyn Buppert. To receive The Green Sheet for the next 12 months, send your name, address and a check for $25 to The Green Sheet, Law Office of Carolyn Buppert, 1419 Forest Drive,Suite 205, Annapolis, MD 21403. A companion newsletter The Gold Sheet, keeps NPs up-to-date on quality issues, including malpractice avoidance and evaluation of clinical performance. The Gold Sheet is also $25/year.

Updated February 2, 1999


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