Tuesday, 15 July 2014

Pre-operative Consultation CPT 99241, 99275 - v72.81 , 336.13

Pre-operative Consultation

The appropriate consultation code (99241-99275) may be reported for a preoperative consultation performed by any provider, to include a patient’s primary care provider, at the request of a surgeon, as long as all the consultation requirements are met and the service is medically necessary.  

In reporting the diagnosis, it is important to remember that the role of each code is to explain why a service was provided.  In reporting “preoperative clearance” the first diagnosis code used would be the code for preoperative examination (e.g., V72.81 throughV72.84).  

Additional ICD-9 codes for the condition(s) that prompted surgery and for conditions that prompted the preoperative medical evaluation should also be documented and reported.  This underlying condition determines the medical necessity for the “preoperative clearance.”  Other diagnoses and conditions affecting the patient may also be documented and reported if appropriate.


V72.81        Pre-operative cardiovascular examination 
336.13        Anterior subcapsular polar senile cataract – Reason for the patient’s surgery
401.1        Essential hypertension benign – Underlying condition – why medical clearance was needed.

CPT code 99241, 99245 - Emergency department consultation code

Emergency Department Consultations

•    A separate encounter will be created when the emergency department physician requests a consultation.  

•    Use codes 99241 - 99245 to document consultant services when the consultant is called to the Emergency Department to render a consultation at the request of the emergency department.  

•    The consultant will report his work in his specialty MEPRS clinic.  The level of consultation is based on the documentation contained within the medical record.  Documenting the problem(s) to be evaluated by the consultation establishes the medical necessity for the consultation.  The specialist will evaluate the patient and provide separate written documentation furnishing recommendations on the patient’s care.

•    See also Emergency Department referral in the E&M chapter. 

Inpatient consultation codes - 99241 - 99275

Consultations Codes - 99241-99275

Inpatient Consults

An initial or follow-up consultation visit occurs each time a provider, from other than the attending clinic service, provides advice/services/treatment to an inpatient on the hospital unit or ward (inpatient visit) but does not assume responsibility for medical control of the condition.

Follow current procedures for capturing consultation to inpatients, using the outpatient appointment type “walk-in.”  When prompted, “Is this Clinic Visit RELATED to Inpatient Episode of Care?” answer the question, “No.”  This will ensure credit is given to the appropriate B MEPRS code for services rendered. 

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