Are subsequent hospital or office visits prior to surgery billable?

Question:  Are the surgeon’s subsequent hospital visits or office visits between their original consult and the final visit prior to surgery billable? This is not referring to a pre-op H&P or an extra visit to answer more questions from the patient and family members after the decision for surgery.

Here’s the scenario. A surgeon evaluates a patient and determines the patient needs surgery.  The patient agrees.  However, the patient needs various pre-op work-up (echos, MRIs, other diagnostic tests) and may also sometimes require stabilization or consultation from other specialty providers prior to surgery.

These subsequent visits involve checking on the patient’s status and reviewing the various test results and / or waiting for clearance from the other specialists during that interval – could be days, weeks before going to surgery.

Answer: As far as I can see, CPT^® has never addressed this exact scenario.

We’ve all seen the CPT^® Assistant from 2009 that says if the intent of the visit between the decision for surgery and surgery is the pre-op H&P, it is not billable. And, informed consent is included in the payment for the surgical procedure, as well.

Since these visits, as described above, are neither of those, I would bill for those visits in the situation you describe.

View all Everyday Coding Q&A’s