Wiki 99386 with a colonoscopy

[catharine]

Hello All,

My GI doctors want to bill a 99386, with a colonoscopy. While I know for the most part only PCPs can use this code for preventive visits I can not find any information I can print out to give to the doctors to verify this. At least nothing current. Can anyone point me to a recent link that I can present to my physicians that show that the 99386 series of codes should only be billed by a primary physician and not be used by a GI physician? Or if you happen to have information that shows they can bill this with the procedure I would like that as well.

Thanks for all your help.

 

[navila0508]

no you cant bill that em code, but you can bill a HCPCS code S0285. for visit prior to screening for commercial plans that follow ACA Policy. so far UHC, bcbs anthem, Humana, Aetna Remember the only payable diagnosis for this free visit is z12.11 z80.0 and z83.71

http://www.dol.gov/ebsa/faqs/faq-aca29.html

 

[thomas7331]

Hello All,

My GI doctors want to bill a 99386, with a colonoscopy. While I know for the most part only PCPs can use this code for preventive visits I can not find any information I can print out to give to the doctors to verify this. At least nothing current. Can anyone point me to a recent link that I can present to my physicians that show that the 99386 series of codes should only be billed by a primary physician and not be used by a GI physician? Or if you happen to have information that shows they can bill this with the procedure I would like that as well.

Thanks for all your help.

Wow, some providers really won't stop at anything to try to find a way to bill for something. 99386 is a preventive care visit and physical exam, not a pre-operative service. I don't know of any regulations that says that only a PCP can do this, but some payer policies may require this to be done by the patient's primary care provider, which is usually limited to certain specialties - GI doctors are not usually not available to patients to choose as their PCP. In addition, most payers only cover this once a year for their patients - it's not an unlimited benefit. If the GI providers really were to bill this, they need to understand that they are using the patient's preventive benefit for that year and that they will likely not be paid if the patient has already had the service, or that if they are paid, then they will be causing the patient to lose this benefit if they later want to have their physical with the PCP. Not to mention the more obvious fact that it's just not an appropriate way to code a pre-operative visit unless they really intend on offering and giving the patients the comprehensive service that this code requires.

Rather than look for information that says they can't bill for this, I would recommend you pull up a few patient benefit summaries and look at the preventive care benefits and PCP guidelines, and try to show the providers that billing this way would just not be appropriate and could also have negative consequences for their patients by exhausting their benefit.