Colonoscopy Coding

kathy a

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I really seem to be struggling with patients that come in for screening colonoscopys.
The patient comes in for a screening, and is a new patient referred by their family physician. According to Medicare guidelines we cannot bill for that pre-op-even though our physician has never seen that patient before-unless patient has a problem that is revealed during that exam, or is on Coumadin. So if our doctor sees that patient prior to the surgery-which he does-it is coded as a freebie or post op charge. Patient then has their colonoscopy and our doctor brings the patient back in to give them their results.Since colonoscopys have a zero global period-can we bill them for that post op visit?
Or is that considered part of the global surgical package?
Thanks...Kathy Albert,CPC
 
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Pensacola, Florida
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You are correct. You can't bill Medicare for a screening pre-op visit. Our doctors don't see referred patients before a screening colon. (Probably because they won't get paid). The staff does a pre-op questionnaire, then on the day of the colon, the Dr. does an H&P. The patient gets results same day, unless there is pathology, in which case they send the patient a letter with the results. Now, if there happen to be other findings, and the Dr. wants to see the patient for a follow-up visit to further address those findings, then we bill the follow up visit with their diagnosis as the reason for the visit. I don't think you can bill Medicare for an office visit solely for the purpose of giving the patient results of a screening colonoscopy. Hope this helps.
 

kathy a

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Thanks so much. If you go online or even our web-site-some say to bill for them-and I know thats not right. We have doctors who insist that they can charge for a pre-op-and when you try to explain that you cant-then they say well if theres no global-then I should be able to charge for the post op? So -bottom line-you cannot bill for a pre-op unless there is a problem or patient is on coumadin. You cant bill for a post-op unless something was found? Even say diverticulosis? You have been a tremendous help. Our doctor wants to bill pre and post op. I will show him this. Thanks so much.
Kathy Albert,CPC.
 
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Location
Pensacola, Florida
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I don't have anything in writing to back this up, but I would think that if the sole reason to bring the patient back was to tell them they had diverticulosis - that they aren't going to do anything about - I don't know about that. There are other forum posts about pre and post-op visits when patients are on Coumadin, but to be honest, I don't follow those. I also don't know about commercial carriers. Some may allow it. You may want to go back to those older forum posts to see if someone happened to mention a link to an article or processing manual that addressed this issue. Hopefully, you'll also get some other responses to this post. If your Dr is a member, another option would be to send an email to the AGA's coding hotline. Sometimes I think I know the right answer because that's how "I've always done it" or what I've been told, only to find out I'm wrong! :)
They may have loads of experience in this area and shed things in a different light.
 
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