• Best of E-Talk: History and Physical Requirements Before Surgery


    Question: Where can I find Medicare guidelines pertaining to the history and physical requirements prior to cataract surgery? The surgery center wants our H&P to be completed within 30 days of the surgery, but some patients want to wait three to four months.

    Answer: An H&P is required and must be performed not more than 30 days prior to the date of any scheduled surgical procedure, regardless of the type of procedure (Title 42, Part 416.52(a)(1) of the Code of Federal Regulations). The regulation does not exempt ASCs that perform less-invasive procedures from the requirement for a comprehensive H&P.

    That being said, you need to find out what level of H&P your facility typically requires. Some have a fairly standard protocol, while others allow more flexibility on the part of the surgeon in determining whether they refer the patient out to their primary care physician or perform the exam themselves.

    The Academy has long advocated that, for most cataract surgery, reducing such pre-op testing could save the program money. For a list of other questions you and your patients should consider before making decisions about pre-op testing for routine eye procedures, be sure to check out the Academy’s Choosing Wisely guidelines.