Q&A: Billing for pre-admission testing

Q: My team is asking me if we should combine pre-admission testing (PAT) visits with the surgery bill. I'm thinking no because some of the PAT services are not routine for the surgery. However, isn't there a rule about services that can't be billed separately prior to surgery?

A: For outpatient services, where the PAT is performed on a separate day than the surgical procedure, there is no requirement that the PAT be on the surgery claim. This was a practice many years ago that had as much to do with getting everything on the same account number as it did with billing requirements. This is no longer a concern with the advent of electronic records. There should be medical necessity documented for the testing, but it goes on its own claim when performed on a date of service separate from the surgery. I would also investigate why the question has been asked. What is the impetus for combining the services on a single claim? This may reveal another process that needs some attention. For example, the situation may be that medical necessity is not clearly evident from the information provided in the order. Anesthesia may order a chest x-ray on someone because they are of a certain age, but this may not be considered to support medical necessity from a payer's perspective.

Editor’s note: This question can be found in the Billing and Claims category on the NAHRI Forums where you can find answers to questions on a variety of topics from billing and claims to compliance to reimbursement. This question was answered by NAHRI Advisory Board member Denise Williams, COC, CHRI.