Wiki Colonscopy on a patient in a SNF

[orthobiller2017]

Hi, new to gastro. Are colonoscopies considered part of SNF consolidated billing? I tried to search CMS website but couldnt find any definitive information. We submitted as an ASC to our local MAC and denied. Not getting anywhere with the SNF itself. Thx!

 

[TThivierge]

Hi Orthobiller
I believe this could be done in the SNF if had place for colonoscopy to be done...need anesthesia and proper equipment. If the provider is ordering it needs a reason such as is patient having digestive problems (R15, K92, K31, R19 Etc) or is it due to annual visit as part of health checkup but done by a gastro physician? Then use as primary Z12.11, modifier 33 or Pt for Medicare patients if prescreening if part of their annual check up on colon/intestines health. If polyps are found on colon use dx D12 block.
This might be done with the gastro doctor's practice not consolidated billing under the contract of the SNF.

Congress then enacted the Balanced Budget Act of 1997 (BBA), Public Law 105-33, Section 4432(b), and it contains a Consolidated Billing (CB) requirement for SNFs. Under the CB requirement, an SNF itself must submit all Medicare claims for the services that its residents receive (except for specifically excluded services listed below). Nope gastro services not included. Seem have to bill the SNF consolidated service then later give contracted fee to gastro doctor later once paid or let the gastro doc bill it at his practice. I imagine pts transferred to gastro office for colonosocpies? .
Reference https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/ConsolidatedBilling

Let me know outcome and hope helped a little bit.
Lady T