Identify and explain the circumstances in which separate allowances are warranted for pre-operative services
What will be an ideal response?
Answer:
The immediate preoperative visit in the hospital or elsewhere is generally necessary to examine the patient, complete the hospital records, and initiate the treatment program. Charges for these procedures are included in the surgical allowance. However, a separate allowance may be warranted for preoperative services in the following circumstances:
a. When the preoperative visit is the initial visit (i.e., in an emergency room), and prolonged detention or evaluation is required to prepare the patient or to establish the need for the surgery.
b. When the preoperative visit is a consultation. Be sure the physician has not "up coded" a preoperative visit to increase benefits. An example is a surgeon billing for a consultation prior to surgery when in fact the visit was a simple preoperative visit.
c. When procedures that are not usually part of the basic surgical procedure (i.e., bronchoscopy prior to chest surgery) are provided during the immediate preoperative period.
d. When a procedure could normally be performed in the office, but under certain circumstances requires hospitalization.
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