Wiki E/M visit with V12.72, V18.51 or V16.0

[Colliemom]

When a patient is seen in the office, and the only dx is V12.72, V18.51 or V16.0 is this a billable service? We know and E/M code with V76.51 is not considered a billable service, but management wants to double check on these other V-codes.

thanks

 

[mitchellde]

V76.51 is not acceptable for an E&M as it is a screening for colon neoplasm code and an E&M is not a screening procedure, screening V codes should only be used for the encounter where the screening procedure is performed. The other V codes you have listed might provide medical necessity for an E&M but it will depend on the nature of the encounter. If you are trying to bill a pre op for a scheduled screening colonoscopy, Medicare does not allow this unless the patient has other issues unrelated, other payers tend to follow this.

 

[Colliemom]

Thanks. We know an E/M visit with the V76.51 is not a billable service with Medicare plans. What they are asking, would the other dx codes warrant evaluation, and provide medical necessity for an E/M visit for Medicare patients?

 

[jquinones]

V12.72

V12.72 per medicare this is a payable dx for an e/m code. the other codes are not payable and are bundled into the colonoscopy