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Billing for Preoperative/Preadmission Services - new requirement effective 6/15/2012

Release Date: May 3, 2012

Preoperative/preadmission testing is the necessary laboratory and X-ray testing performed on an outpatient basis prior to a scheduled inpatient admission to a hospital. These necessary services are rendered by or accepted by the admitting hospital.

Effective June 15, 2012, Blue Cross and Blue Shield of North Carolina (BCBSNC) will begin requiring all preoperative/preadmission services performed at the hospital, be included on the UB-04 claim form when used to report scheduled admissions/surgeries. This change is being made to allow for consistency with industry standards for UB-04 claims submission.

Below are some general guidelines when submitting claims for preoperative/preadmission testing: 

Preoperative services performed at the hospital prior to a scheduled inpatient admission  

  • Charges for preoperative services/testing related to surgery should be included on the same bill as the surgery, whether or not the testing was provided on the date of surgery. For an inpatient claim, the “From Date” and “Admission Date” may be different, as the “Admission Date” will be the date the patient was admitted to the hospital while the “From Date” reflects the date pre-operative services were performed.

Preoperative services performed outside the hospital prior to a scheduled inpatient admission 

  • Charges for preoperative services/testing (i.e.; radiology services, lab services) performed outside of the facility, prior to a scheduled inpatient admission, should be billed separately on a CMS-1500 claim form. 

Remember, prompt processing and payment of claims is contingent upon proper claim submission.  Please ensure that your facility is correctly billing for preoperative/preadmission services.  Additionally, we encourage you to review your facility's BCBSNC contract regarding preoperative/preadmission testing for scheduled admissions/surgeries to determine your contractual obligations.

Questions regarding BCBSNC’s policy for reimbursement of preoperative/preadmission testing should be directed to the Provider Blue LineSM at 1.800.214.4844.