Billing Screening Colonoscopy Work Up


Best answers
One of my providers is asking if he can bill a screening exam for a patient who ended up deciding not to have the colonoscopy performed. The patient did not present with any symptoms and was otherwise healthy, so the only diagnosis we have to bill is the Encounter For Screening Z12.11.

I understand Medicare considers payment for the pre-op visit inclusive to the screening colonoscopy reimbursement, however, what happens when that procedure is not performed?


True Blue
Best answers
A screening exam is not a covered benefit under Medicare. Medicare only covers services that are for the treatment of an illness or injury, with the exception of the those specific services that are listed under their preventive benefits. If the patient did not present with a specific complaint, or receive evaluation or treatment for a problem, then you cannot bill a problem-oriented E&M visit code for this. You may be able to bill this as an unlisted preventive service in order to get a denial so that you can bill the patient, but I'd give some consideration to whether or not you really want to do this as it's likely to generate a complaint from the patient that may be more trouble than it is worth.