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Charge and bill Medicare all pre-operative diagnostic tests

APCs Weekly Monitor, September 30, 2005

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Charge and bill Medicare all pre-operative diagnostic tests

QUESTION: Can our facility charge for pre-op testing by hospital staff 10 days prior to the hospital procedure? For example, can we charge for the room and any other ancillary functions? Also, what charge category should we place this under?

ANSWER: You can separately charge and bill Medicare all diagnostic pre-operative testing. This is true whether the testing occurs 10 days before surgery or one day before surgery.

If the surgery is an inpatient procedure, include all diagnostic tests performed up to three days before the inpatient admission on the inpatient bill. Otherwise, you must submit separate outpatient claims for the diagnostic tests.

Whether or not you can bill an E/M or "room" charge depends on what medically necessary service is rendered by the physician. If a physician or other allied health professional evaluates the patient and then orders pre-surgery diagnostic services, it is appropriate to bill an E/M code.

If a nurse merely executes orders from a medical staff physician--and then gives pre-operative instructions--you may or may not be able to bill separately for the service with an E/M. The decision depends upon what type of services are rendered and whether they meet medical necessity.

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