Gastroenterology Coding Alert

Some gastroenterologists are now getting reimbursed for an E/M service prior to a screening colonoscopy by filing their claims with a preoperative examination diagnosis code. While some payers may be covering these claims, gastroenterologists should be aware that this is not a uniform practice, and many coding experts do not believe that the prescreening E/M is a reimbursable service. Although many gastroenterologists perform a full evaluation of a patient before a screening colonoscopy (G0105, G0121) is scheduled, most physicians consider that E/M service preventive and therefore nonreimbursable. However, CMS issued Transmittal 1719 on preoperative services in August 2001, which many gastroenterologists are using to justify billing the prescreening E/M as a preoperative exam.

The memo instructs carriers that they should not automatically deny claims for preoperative clearance examinations. "Services identified with ICD-9 codes V72.81 (Preoperative cardiovascular examination) through V72.84 (Preoperative examination, unspecified) are not considered routine services and may not be denied, by carriers, as routine services," the memo states. "However, these ICD-9 codes do not, in and of themselves, establish medical necessity, therefore claims containing these codes may be subject to medical necessity determinations as described in [Medicare Carriers Manual section] 15047 H." Use V72.83 as Primary DX After reading the memo, Linda Parks, MA, CPC, lead coder at Atlanta Gastroen-terology Associates, decided to do a test by filing 20 claims for an E/M service prior to a screening colonoscopy with V72.83 (Other specified preoperative examination) as the primary diagnosis. Her test proved successful. "I waited a few weeks, and 19 of them were paid," Parks says. Medicare and various private payers paid the claims. Parks uses V76.51 (Special screening for malignant neoplasms, colon) as the secondary diagnosis so the payer knows this is being done with a screening colonoscopy. In addition, the gastroenterologist dictates that this is a preoperative exam by noting in the file that the patient is cleared for surgery. Parks believes that this is in keeping with the instructions in the transmittal, which also revised the instructions for reporting preoperative exams. (Revisions are in italics.)

"All claims for preoperative medical examination and preoperative diagnostic tests (i.e., preoperative medical evaluations) must be accompanied by the appropriate ICD-9 code for preoperative examination (e.g., V72.81 through V72.84)," the transmittal states (this is also in MCM section 15047[G]). "Additional appropriate ICD-9 codes for the condition(s) that prompted surgery and for conditions that prompted the preoperative medical evaluation (if any), should also be documented on the claim. Other diagnoses and conditions affecting the patient may also be documented on the claim, if appropriate. The ICD-9 code that appears in the line item of a preoperative examination or diagnostic test must be the code for the appropriate preoperative examination (e.g., V72.81 [...]