Gastroenterology Coding Alert

A simple checklist may be the answer to all your problems
 
If you-re uncertain whether you should count an asymptomatic precolonoscopy screening as a reportable E/M service, you-re not alone. Check out this expert advice and see where you stand.

Scenario: Before scheduling a screening colonoscopy (G0105, G0121), your gastroenterologist evaluates a patient to make sure he has no conditions that would put him at risk during the procedure. If the patient has a risk factor that the gastroenterologist thinks needs further exploration, he might schedule an additional E/M service appointment before the colonoscopy.
 
Should your report an E/M service or count this visit as part of the colonoscopy?

Evaluate E/M Visit Option

Some coding experts contend that you can count a precolonoscopy screening as an E/M service.
 
You would report 99201 (Office or other outpatient visit for the evaluation and management of a new patient ...) with diagnosis codes V72.83 (Other specified preoperative examination) and V76.51 (Special screening for malignant neoplasms; colon) attached to strengthen the claim. These codes prove the gastroenterologist performed the E/M service to ensure a new patient's safety before a colonoscopy.

Reasoning: -If you do decide to submit a claim for a patient with no symptoms, you have to code it as a new patient or established patient visit,- says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.

Good idea: Have the patient sign an advance beneficiary notice (ABN) so you can collect this amount from the patient if his commercial insurance carrier won't cover a visit with no symptoms, says Connie Pitman, a coder in Lubbock, Texas.
 
But that's not usually the norm, Pitman says: -We-ve found that a Medicare patient often has some symptom that will make this a payable visit, such as a change in bowel habits or constipation. Just make sure you-ve got documentation for it.-

Include It as Part of the Colonoscopy

On the other hand, you know that CMS considers a routine preoperative E/M visit (V72.83) prior to a screening colonoscopy (G0121) as included in the screening service. For that reason, you can consider this pre-op visit as a nonreportable visit.

-In my opinion, if you schedule the patient for a screening colonoscopy, there should be no charge for the prescreening visit,- Parks says. -The only time you would charge for a prescreening visit would be when the patient has other symptoms that would make this service diagnostic rather than screening.-

Just because you consider this visit a no-charge, however, you still have alternatives to a full-fledged E/M service code.

Alternative 1: Formulate a Checklist

Did you know? You can formulate a precolonoscopy screening checklist. The checklist should contain all factors that may put a patient at risk during a colonoscopy. Once you have created a checklist, you have several options for asymptomatic precolonoscopy screenings that do not involve single-patient office visits.

A nurse can call the patients individually and review the checklist with them to rule out any risk factors. -If they have nothing to warrant an E/M visit, we just schedule the colonoscopy,- Parks says. Faxing the checklist to the patient's primary-care physician and asking him to review it with the patient is also a viable option, she adds.

Alternative 2: Don't Forget About Group Screenings

Another method is conducting group precolonoscopy screenings, then scheduling E/M visits only for patients who require them.

What it is: Group screenings involve a nurse practitioner (NP) or physician assistant (PA) conducting a session with 10 to 15 precolonoscopy screening patients. When the patient reports for the session, present him with your office's checklist and have him fill it out.
 
Then have the NP or PA -explain the prep and procedure and go over the checklist with the entire group,- Parks says. -If there's anything on the checklist that draws attention, then the patient is scheduled to see the physician before the colonoscopy.-

Stay smart: Get a consensus with your fellow coders and gastroenterologists to discuss the practicality of each of the alternative asymptomatic precolonoscopy screening options. Decide whether each option is feasible for your office, and then start work on a precolonoscopy screening checklist if the office decides to use one of the methods.