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E/M with Colonoscopies

F

frankal

Contributor
Messages
19
Location
Pocahontas, IL
If a pt is referred for screening colonoscopy and the provider doing the colonoscopy does an H&P prior to the colonoscopy the same day, can the H&P be charged also? If the E/M code cannot be charged due to it being screening and the screening turns into dx, THEN can an E/M code be charged?

So confused!
 
We bill for the visits prior to the colonoscopies using the Z01.818 dx code if they have no symptoms or histories. We do get the visit paid coding with this.
 
I disagree. A chief complaint is a requirement for all non-preventive E&M codes, and there is no medical necessity to justify billing an E&M for an asymptomatic patient with no comorbidities. The decision for surgery and the evaluation of the patient prior to the procedure is a component of the global package for all endoscopies - this is clearly spelled out in CMS and most other payer global surgery policies. The reimbursement for these procedures has been calculated to include the physician work involved in evaluating the patient and making the decision to perform the procedure. Billing an E&M visit for the routine evaluation of a patient prior to a scheduled procedure is unbundling and inappropriate.
 
I agree you can not bill an E/m service not even with a modifier. /And for those getting paid,just because you are getting paid for it doesn't mean you wont be audited for it later. I would be cease any further billing for that .
H&P before an already scheduled colonoscopy on the same day? Really? This sounds like poor Patient Care.
 
E/M with Colonoscopies-facility billing

I have spent a considerable amount of time trying to research this topic for hospitals reporting an E/M for the facility services related to the hospital based clinic visit with the GI provider prior to a screening colonoscopy(asymptomatic patient). I am having no luck finding a definitive answer on if the facility can report an E/M in this situation and if they can what the diagnosis would be. They are not billing for the physician, only the facility resources.

Does anyone have any information to help me determine if the facility can report an E/M in this situation?
 
Outpatient facilities are still subject to the same NCCI coding rules as professional claims for E&M services billed on the same day as a procedure. A modifier 25 would be required for separate payment and the modifier would have to be supported by documentation of significant and separately identifiable E&M. The main difference facilities have from professional in this case is that global surgery rules don't apply to the facility, so outpatient E&M visits for pre- or post-operative on a different date of different from the procedure can be billed and paid under OPPS rules.
 
Thanks Thomas, these visits are not on the same DOS. Even though global rules don't apply to the facility do you know if the facility charge for the E\M is paid from the preventative service benefit if the screening dx is on the facility claim? CMS has said the visit is not billable for the provider in this situation, trying to understand if its covered under the preventative service benefit will it be ok for the facility to charge their E/M. Any info is greatly appreciated.
 
Medicare does not offer a preventive benefit for E&M services (other than the limited IPPE and AWV), regardless of whether it is a facility or professional charge - Medicare covered preventive services are limited to just those that are specified in the regulations, which in this case would be the colonoscopy, but not any associated preventive E&M service. In order to meet coverage requirements, an E&M service on a different day would have to be medically necessary for treatment of an illness or injury, so if the service was purely preventive in nature, it would not qualify for coverage.

A routine pre-op E&M for an otherwise healthy patient is a component of the global package for a colonoscopy. Many gastroenterology practices safely evaluate their patients for a colonoscopy with a phone or written questionnaire, and with a physician evaluation just prior to the procedure, and only schedule the patient for an in-person visit if there are issues or comorbidities that require a more extensive evaluation by the physician. Because this is a common practice, in my opinion it would be difficult to argue for the medical necessity of a separate E&M visit for every screening colonoscopy patient unless there are documented problems that require that service.
 
I bill for the physician and she sees the patient in the office to exam them and discuss their history and concerns. The colonoscopy is done on a different date and at a different location. That is why we bill for the consult before the colonoscopy. If she was to do the colonoscopy the same day as the visit then we would only bill for the colonoscopy.
 
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