Wiki Anyone else having trouble getting Colo Consults paid?

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mguevarra

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I work for colon and rectal surgeons who perform many colonoscopies. Typically new patients have a consult with the doctor or PA before they are scheduled for their colo. If the patient has no other diagnosis we use V76.51 along with the 9924X. Some insurances have been denying due to the diagnosis. Any suggestions on getting these consults paid?
 
You can't bill those as consults. They should be new patient visits or established. Even if you code them as new or established a lot of insurances will still not pay. I recently went to a seminar and according to the speaker from McVey you should not be billing for a visit prior to a colonoscopy if the patient is not having signs or symptoms. According to Medicare guidelines it is bundled in the procedure. Her suggestion was to not bill it at all but if your doctor's insist on seeing the patient have the patient sign an ABN prior to the visit so that they know that they are going to be responsible. Hope this helps!
 
I agree, these are supposed to be bundle into colonoscopy procedure. So if your going to see the paitent anyways. Code them as New Patient. Go through the notes, and if it's for an PPO insur. Pull out DX's of HTN, DM, or some chronic condition they more than likely have. If they don't have anything then your stuck with V76.51. It's not in compliance with medicare, to be seeing the paitent for a consult prior to a colonoscopy. So I suggest you give your physician a heads up.

Daniel
CPC
 
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