Preoperative Visits

For Scheduled Major Surgical Procedures

A major surgical procedure is considered by HMSA to be any procedure that has a 90-day postoperative period. A global surgery fee is paid for all necessary services rendered before, during and after a major surgical procedure.

The preoperative visit or evaluation is included within the global surgery fee. During this visit, the surgeon may:

• Discuss the surgery to be performed.
• Evaluate the patient's physical condition and ability to tolerate the planned surgery.
• Present and discuss the appropriate consent forms.
• Prepare admission documents.

Any evaluation and management (E/M) service (e.g., visit) rendered the day prior to surgery and related to the surgical procedure is considered part of the global surgical service.

Claims Filing Information

For surgeons who render surgical and preoperative services: In processing claims for major surgical procedures, HMSA recognizes only the procedure code that applies to the surgery performed. Separately billed preoperative visits are not eligible for payment.

Claims that are submitted with one of the following diagnosis codes as the sole diagnosis will be automatically denied:

• Z01.810
• Z01.811
• Z01.818 

Preoperative Visit that Resulted in the Initial Decision to Perform Surgery

Identify this visit with modifier code 57. HMSA will review payment for the claim. If modifier code 57 is not used, the visit will be considered part of a scheduled major surgical procedure. (See Modifier Code 57).

Revision History