Office Visit before Screening Colonoscopy


Spring Lake, NJ
Best answers

Healthy patient comes to office for AWV and wants a screening colonoscopy (1st one).
Dr. does H&P procedure is scheduled 3 weeks out.
Does our office just bill for AWV Z00.00 and/or for Post Procedural Examination Established patient 99215 E/M using code Z01.818?
If its the Established E/M after Z01.818 would I use code Z12.11? this concerns me using Z12.11 as that would be the Primary DX on the day of procedure and I am afraid insurance would Deny as already have had a Screening colon?
I have not ever come across this, would appreciate any input here.

Thank you
The only specific code for an office visit prior to a screening colonoscopy when there is no patient problem to be managed is HCPCS code S0285, which some commercial payers cover. You can't really use a problem-oriented E/M code 99201-99215 for a screening - there needs to be a 'chief complaint' for these codes, i.e. some kind of symptom or comorbidity that requires the physician's evaluation in order to clear them for the procedure. An AWV or other preventive service code is not correct (and not really appropriate for a specialist) unless the physician is performing all of the required components of that code and not just clearing them for the procedure.

I know that many GI groups will clear a healthy patient for this procedure with a simple questionnaire that can completed online or over the phone and be reviewed by a staff member, and they only bring the patient in for a visit if the questionnaire turns up an issue that requires the physician's additional time and attention. The routine pre-operative work for a healthy patient is considered inclusive to the procedure itself and doesn't warrant a separate E/M service unless there is a specific issue that needs to be addressed.
Hello Surfergirl🏄‍♂️
Ahh let me add some not bill with CPT 99215...that is for life or death immediate situation in which pt is sent to EMR or high risk illness. Dx Z01.818 is for pt getting ready for surgery then add modifier 57 to that office visit code. A colonoscopy is not considered surgery but prescreening for colon cancer. I d use the dx Z00 if pt got a physical annual wellness and 2nd dx code as Z11.12 . I' d use preventive CPT code not 99215 see CPT codes 99381-99397 use per pts. age since established pt link with dx Z00
I am just trying too help.
Lady T:)
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