Billing a 99213 with a colonoscopy/egd

dfanel

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We have a new Dr to our practice who wants to bill a 99213(w/modifier 25) with a procedure such as a colonscopy or egd, etc. He is seeing the pt in the office for a visit before and after the procedures. We think this is wrong to bill on the same day as the procedure, Since he is only doing the basic H & P and nothing over and beyond this..Can anyone tell me what their experience is with this and what if any repercussions could be taken with this type of billing. Any feed back on this topic would be great.
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tpontillo

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This is wrong. You cannot bill for an office visit if the patient is already scheduled for the procedure. If the patient came in for an office visit and during the visit the dr then said the patient needs the procedure done that day then you can bill for the office visit.

Look at the last two questions on the following link:

http://www.gastro.org/practice/practice-management/coding-faqs#28
 
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