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Reminder: Hospital Billing for Preoperative and Preadmission Services

Please note:  Preoperative and preadmission services should not be split-billed from the inpatient claim, as this causes an overpayment of the services in question and will result in a refund request by BCBSNC. This article was originally posted in May 2012 and revised in November 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.

As of June 15, 2012, Blue Cross and Blue Shield of North Carolina (BCBSNC) began requiring that all preoperative/preadmission services performed at the hospital within 72 hours of the admission be included on the UB-04 claim form when used to report scheduled admissions/surgeries.  This change was made to allow for consistency with industry standards for the submission of UB-04 claims.

Below are some general guidelines to keep in mind 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 on which the preoperative services were performed.

Preoperative services performed outside of 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 performed within 72 hours of the patient’s hospital admission.  Additionally, we encourage you to review your facility's BCBSNC contract regarding preoperative/preadmission testing for scheduled admissions/surgeries to determine your contractual obligations.

If you have any questions, please contact the Provider Blue LineSM at 1.800.214.4844.