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Office Visit Prior to Colonoscopy

A

ashley.roberts@nchmd.org

Contributor
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I know this question is on the threads a thousand times, but I cannot find any information on an office visit prior to a screening colonoscopy other than what the American Gastro Association has to offer. I realize an office visit prior to a screening colonoscopy is bundled with the procedure for a patient that required no intervention prior to the procedure, but what conditions constitue intervention besides the patient being on Coumadin? What if the patient has heart issues and the Gastro physician refers for cardiac clearance prior to the surgery? Is it only approrpiate for the cardio provider to bill for their services since they follow the cardiac condition or is it appropriate for a Gastro physician to bill for an office visit prior to the colonoscopy in this case? I am really struggling with finding any additional information and now I have researched this so much I am getting frustrated. :mad: I would really appreciate someone's help! :)
 
Cardiac is for Cardiac Speciailist

As for our physicians, cardiac issues are to be taken up with Cardiac experts and the clearance is up to their profession. If the patient has upper GI issues and is seen prior to a screening colonoscopy, that visit is covered for those diagnoses.
But, other than that, the Medicare patient needs to sign an ABN if they insist on the visit with no symptoms, or the commercially issued would have to be notified that it will not be covered by their issurance.
Hope this is helpful! :)
Kathleen Wolfe
GI biller since 2006.
 
Thank you

Thank you Kathleen for the response. This is pretty much what we were thinking, but our GI physician feels like weight loss, cardiac clearance and many other issues allow him to be able to bill for the visit prior. I have informed him if the patient presents with symptoms it is no longer a screening at that point so both the colonoscopy and appt prior would be able to be billed separately, and with the cardiac clearance issue I informed him if he's not following that condition he shouldn't bill for the visit. I know coumadin is one issue that the American Gastro Assoc has idenitied as requiring intervention prior.
 
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