Understanding E/M: Preop H&P not separately billable, CPT® confirms

Why This Topic Matters

Preoperative visits are a common source of billing confusion, especially when hospitals require them as part of preparation for surgery. Understanding how CPT and Medicare treat these encounters helps practices avoid incorrect reporting and align physician education with payer policy.

Article Sections

1. Preoperative H&P and the surgical package

   Covers the general question of whether a pre-surgery history and physical visit is separately billable when surgery has already been scheduled. The section discusses how this type of encounter fits into the broader surgical service.

2. CPT clarification and Medicare policy

   Summarizes the article’s references to CPT Assistant and Medicare guidance on preoperative visits and global surgical coverage. It also notes the use of official CMS resources cited by the article.

3. When an E/M visit may be separately reportable

   Addresses the distinction between an included preoperative H&P and the visit in which the decision for surgery is made. The section also references related reporting considerations for decision-making encounters.

4. Medical necessity and consultation context

   Discusses the role of underlying medical conditions and preoperative clearance visits that may involve other clinicians. It places these encounters in the context of surgical preparation rather than the orthopedic surgeon’s routine pre-op H&P.

5. Official resources

   Lists the external CPT and CMS resources cited by the article for readers who want to review the underlying guidance.