Consultation for screening colonoscopy

[wendypwrightcpccemc]

I have two questions: The first is, is it appropriate to bill for a consultation (all consult guidelines met) when the patient is coming in for a screening colonoscopy. The patient has a strong family history of colon cancer in his father and brother and mild internal hemorrhoids with intermittent bleeding. Also for this same patient do you think according to the table of risk the patient falls into moderate risk?

Thanks,

[mcpalmeter]

You indicated in your post that all of the consult requriements were met. Well, exactly what advice/opinion is being requested of the GI doc if the service is a screening? Sounds to me like the referring physician just wants the patient screened and wants to know what the results are.

Also, a screening colonoscopy was priced by Medicare to include the usual pre-op assessment on the patient. As such, the consult should not be billed in addition to it.


Maryann Palmeter, CPC

[acbarnes]

See AGA guidelines for billing for an E&M (Consult or New Patient) for patients sent for screening colonoscopy. You cannot bill unless an E&M was performed and documented. In the case of a patient with no signs or symptoms, what are you evaluating and managing? Basically, the PCP just wants you to perform the procedure and your review of the history is part of the pre-op work-up.

However, according to your message, the patient complained of internal hemorrhoids with bleeding. You can bill the appropriate E&M for the Hx, Exam, and MDM of this diagnosis and symptoms.