Many facilities will require a preoperative history and physical within 30 days of a procedure. Does this requirement from the facility support the medical necessity of an E/M visit? The answer is maybe. Medicare transmittal 1719 states, "For purposes of billing under the Physician Fee Schedule, preoperative medical examinations performed by, or at the request of, the attending surgeon does not fall within the statutory exclusion articulated in §1862(a)(7) of the Act. These examinations are payable if they are medically necessary (i.e., based on a determination of medical necessity under §1862(a)(1)(A) of the Act) and meet the documentation requirements of the service billed."  When researching on the World Wide Web, there seems to be a lot of controversy related to the billing of these services and whether they should be billed as a consult or a new vs. established patient off...

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