Question HPI in E/M Leveling

nicoleysmith

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When leveling a GI office visit where the reason for the visit is to plan a screening colonoscopy with no presenting problems, what information are we allowed to use under the HPI section of an E/M Leveling sheet? My team lead and I are trying to determine if we can use "location" since we know the location for the procedure of the colonoscopy - there are no symptoms, no personal or family history of cancer or polyps, no digestive issues, etc. Is there any other information we should use when determining the extent of the HPI for a non-problematic, screening colonoscopy?
 

thomas7331

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The visit you describe would not be appropriately coded with an E&M level since those are problem-oriented visits and there is no problem for the provider to evaluate and manage. A screening is by definition a preventive service and shouldn't be coded as a service directed at the evaluation and treatment of an illness. You can use HCPCS code S0285 to represent this service - some payers do have a benefit available for patient to receive this.
 

Pathos

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I agree with Thomas, and to just add to his answer; remember that the History of Present Illness describes the condition the patient came in for. Even if there was enough medical necessity for an E/M visit, "Location" would not be appropriate to describe the location of the procedure. I can understand if you looking for anything to support an E/M, but like Thomas said, the type of visit you are describing is really a preventive benefit, and not a problem focused E/M.

The CMS E/M guidelines explains further the HPI components.

Hope that helps!
 

Pathos

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Thank you both. Is this code also accepted by commercial insurance?
S-codes are generally payer specific. That means that you will need to check on the patient's insurance to see if they accept that code. I know Medicare doesn't accept these S-codes, since they have a different benefit to cover these services.

Hope that helps!
 
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