Wiki ANOSCOPY & E&M svc done same day-CAN ANYONE

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PAULA FEDELE

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CAN ANYONE POINT ME IN THE RIGHT DIRECTION TO FIND DOCUMENTATION STATING YES OR NO ON BILLING AN ANOSCOPY 46600 WITH ANY E&M service done on the same day & the decision made that E&M session. There's discussion that it's over billing & the anoscopy is part of the exam portion of the E&M. Thanks
Paula
 
What I just advised our doctor who does these procedures is if it the patient is a new patient, yes, bill the E/M with the procedure. If patient is not new, no, just bill the procedure.
 
I struggle with this one as well.
But I do know for sure New patient vs Established should NOT determine whether or not an E/M is charged. NCCI clearly states that....
"The fact that the patient is new to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure."

This is from Chapter one of the NCCI edit general coding guidelines!
 
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This is a topic we have been tossing around my office for awhile now and would like to see if there is some new thoughts out there. I know you should not bill based upon new and established patients, but CCI edits are there for established patients and not for new patients. When do you feel it is appropriate to bill both an E/M code and the anoscope and if not appropriate to bill both which would you bill?
 
I have never heard of or seen where CCI edits only apply to new or established.
They apply to BOTH!

Please see the CMS website and look up the CCI policy manual. To bill an office visit you will need to satisfy the requirements for the 25 modifier.
It needs to be SIGNIFICANT and SEPARATELY IDENTIFIABLE form the Anoscopy note.
A good tip would be highlight everything related to the Anoscopy andsee what you have left what ever is not related to the procedure and not highlighted, if it levels to an exam then you can most likely charge a visit with the 25.
Remember the decision to have the procedure done is included in the Anoscopy charge. So everything in the document leading to that decision is part of the decision and not separately identifiable!
I will try to attach a document for you to review the E/M section.

https://www.cms.gov/Medicare/Coding...ndex.html?redirect=/nationalcorrectcodinited/
 
If you enter a new patient code and 46600 into any CCI edit tool (encoder pro, clear claim and even AAPC new coder program it comes up without an edit and it comes up with an edit for established patient. My patients are coming in for an office visit for a colo-rectal problem and not a scheduled anoscope. What makes this any different than me going into my doctor for a earache and they use a scope to look in my ear. I have never been charged for that just the office procedure. I am really confused on this and trying to understand it.
 
suzanneloeb said:
If you enter a new patient code and 46600 into any CCI edit tool (encoder pro, clear claim and even AAPC new coder program it comes up without an edit and it comes up with an edit for established patient. My patients are coming in for an office visit for a colo-rectal problem and not a scheduled anoscope. What makes this any different than me going into my doctor for a earache and they use a scope to look in my ear. I have never been charged for that just the office procedure. I am really confused on this and trying to understand it.
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Hello, I wanted to know if you got any additional responses on this. I feel the same way that if a scope is to look in my ear it would not be separately reportable. I have not been billing the anoscopy but I'm being told the anoscopy is diagnostic and aided in the decision making. Thoughts!! My understanding is that it is a "peek" at the area which is the reason for the visit just like when they look in your ear. If they did a biopsy then of course that is separately reportable.
 
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