Wiki Healthy Colonoscopy follow up...medical necessity??

[twalls]

Pt comes back in for results of the colonoscopy, they have already come in for a pre-appt that wasn't billable because they were healthy, now they are coming for their results...unnecessary? Thanks for your thoughts..my thought is send him a letter and see pts that need to be seen.

HISTORY OF PRESENT ILLNESS: ..... is a 55-year-old male who
comes to the office on 01/31/2019 for a followup for a
colonoscopy. The colonoscopy, the patient states that he had a
good prep. It did not make him sick. He does not remember the
procedure, and he had no ill effects from the procedure. He is
in zero type pain at the present time.

PHYSICAL EXAMINATION: General: Demonstrates a 55-year-old
white male, oriented x3, pleasant and cooperative.
Vital Signs: Temperature 97.6, pulse 57, respirations 20, BP of
132/78, 6 feet tall, 248 pounds, 97% on room air. 0 pain at the
present time.
Lungs: Clear to auscultation bilaterally. No rales, rhonchi or
friction rubs. No wheezing. Normal respiratory effort. No
shortness of breath.
Heart: Regular rate and rhythm. No S3 or S4 sounds are heard.
No chest pain during the examination. No bruits heard over the
carotids or aorta. No swelling to the lower extremities.
Abdomen: No masses in the abdomen. No tenderness. No
organomegaly. No evidence of hernia.

We reviewed the following material for this visit.

CURRENT MEDICATIONS: We reviewed his medication list.

IMAGING: We reviewed the chest x-ray from 01/04/2019.

LABORATORY: We reviewed his blood work from January 4, 2019.

We reviewed his colonoscopy from 01/25/2019, which demonstrated
2 polyps. We reviewed the pathology report from 01/25/2019,
which demonstrated the 2 polyps to be adenomatous polyps. One
is a pure adenoma, the other one was a tubular adenoma. No
evidence of dysplasia, metaplasia or cancer.

We reviewed the consultation from 01/02/2019.

IMPRESSION: We have a healthy 55-year-old white male who grows
adenomatous polyps.

RECOMMENDATIONS: A repeat colonoscopy in 2 years.

 

[JanRebecca]

I bill for the visits after colonoscopies -- they are coming in to find out what kind of polyps were found.

 

[doxie1064]

High Risk Patient with Adenomatous Polyps

That's a high risk patient, that's why there's another colonoscopy recommended in 2 years instead of 10 years. Tubular Adenomas, Villous Adenomas, Tubulovillous Adenomas, Sessile Serrated Adenomas, and Serrated Adenomas all have the potential to become cancer though they are currently benign-though Villous Adenomas of a larger size are more likely to develop into cancer. Hyperplastic Polyps are typically benign (truly benign-forever) Almost all colon cancers begin as benign polyps that gradually become malignant over time-hence the repeat surveillance colonoscopies with polyp removals and high risk category. It's often necessary to explain after every colonoscopy (and possibly continue to stress) the importance of continued surveillance to patients who only seem to recognize "Benign" or "Malignant" and fail to grasp "Currently Benign but Pre-Cancerous" It's also very important for them to know (Benign vs. Pre-Cancerous) so they can inform their families if this is a new finding.

This is definitely a necessary E/M service.

Also of note: The Global Package for Colonoscopies (and 99.9% of all Endoscopic Procedures) only includes the day of the procedure.

If you're having trouble pulling medical necessity based on the HPI/EXAM/Dx...try having the physician document time spent with X amount spent counseling since the visit is specifically to review results.....

Also, in response to your statement of "Thanks for your thoughts..my thought is send him a letter and see pts that need to be seen."
I personally leave the practice of medicine to the physicians and specialists while I code and bill for the services they provide. If they feel the patient needs seen, then the patient needs seen.

I have personal experience with this same scenario but I was the patient. I was aware of my pathology results. They were listed as "Benign" Since they were Benign, there was nothing to worry about and I didn't even need to tell anyone. I viewed the follow-up just as you do. I thought it was ridiculous. Why should I pay my co-pay to be told things I already know? I don't have cancer....it says it right there! Benign!!!! What my pathology report didn't tell me was that "Benign" includes "Pre-Cancerous" I love the fact that my Specialist took the time to explain this rather than send me a letter. Had he not done that, I wouldn't have been able to explain to my siblings why they were considered "High Risk" and needed to schedule a screening (they're both older than me 5 and 7 years; if they have/had the same kind of polyps they could've already have morphed into cancer and since all I knew to begin with was "Benign"-I wasn't even going to tell them and just leave them completely at risk ) and I can't honestly say that I would've continued with my every 2 year surveillance colonoscopies either because I wouldn't have understood why they were necessary (and the prep is horrible LOL)

Best of Luck!

 

[surfergirl]

Pt comes back in for results of the colonoscopy, they have already come in for a pre-appt that wasn't billable because they were healthy, now they are coming for their results...unnecessary? Thanks for your thoughts..my thought is send him a letter and see pts that need to be seen.

HISTORY OF PRESENT ILLNESS: ..... is a 55-year-old male who
comes to the office on 01/31/2019 for a followup for a
colonoscopy. The colonoscopy, the patient states that he had a
good prep. It did not make him sick. He does not remember the
procedure, and he had no ill effects from the procedure. He is
in zero type pain at the present time.

PHYSICAL EXAMINATION: General: Demonstrates a 55-year-old
white male, oriented x3, pleasant and cooperative.
Vital Signs: Temperature 97.6, pulse 57, respirations 20, BP of
132/78, 6 feet tall, 248 pounds, 97% on room air. 0 pain at the
present time.
Lungs: Clear to auscultation bilaterally. No rales, rhonchi or
friction rubs. No wheezing. Normal respiratory effort. No
shortness of breath.
Heart: Regular rate and rhythm. No S3 or S4 sounds are heard.
No chest pain during the examination. No bruits heard over the
carotids or aorta. No swelling to the lower extremities.
Abdomen: No masses in the abdomen. No tenderness. No
organomegaly. No evidence of hernia.

We reviewed the following material for this visit.

CURRENT MEDICATIONS: We reviewed his medication list.

IMAGING: We reviewed the chest x-ray from 01/04/2019.

LABORATORY: We reviewed his blood work from January 4, 2019.

We reviewed his colonoscopy from 01/25/2019, which demonstrated
2 polyps. We reviewed the pathology report from 01/25/2019,
which demonstrated the 2 polyps to be adenomatous polyps. One
is a pure adenoma, the other one was a tubular adenoma. No
evidence of dysplasia, metaplasia or cancer.

We reviewed the consultation from 01/02/2019.

IMPRESSION: We have a healthy 55-year-old white male who grows
adenomatous polyps.

RECOMMENDATIONS: A repeat colonoscopy in 2 years.

I dont understand why you can't bill for initial OV. Billing as new patient with Z00.00 DX is what I do if they are normal/healthy patient. The physician is still providing a service. We have been paid on this as well as followup visit post colon.