Wiki Office visit screening

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tpontillo

tpontillo

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Our doctors see patients for an office visit and bill V76.51 when they are going to have a screening colonoscopy. They are coming into the office because it is time for their colonoscopy. They do not have any symptoms but the doctor does go over their history and everything else. We bill the office with V76.51. We usually do get paid from the insurance company but one insurance company refuses to pay us. They are saying we are billing with the wrong CPT code. Does any else bill like this or are you billing differently?
 
tpontillo said:
Our doctors see patients for an office visit and bill V76.51 when they are going to have a screening colonoscopy. They are coming into the office because it is time for their colonoscopy. They do not have any symptoms but the doctor does go over their history and everything else. We bill the office with V76.51. We usually do get paid from the insurance company but one insurance company refuses to pay us. They are saying we are billing with the wrong CPT code. Does any else bill like this or are you billing differently?
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You are correct in the way you are reporting this service. I wonder if you quote the coding guidelines to the insurance company in an appeal letter if you can get them to change their policy.
 
From all the info I've gathered Medicare and some other payers will not pay for office visits when the primary diagnosis is a screening. Most of my doctors don't even bill an office visits for screenings.

Bob
 
I havent appealed this yet. I had called the insurance and they told me that they wont pay like it is being billed. I know Medicare doesnt pay for this and we have the patient sign an ABN for it.

Bob why are you not billing for these? Our doctors see these patients in the office and still go over their history and examine them. Is there a reason you are not billing the office visit?
 
I'd have to ask this set of docs, some of mine do, but others just want the office visit included in the procedure. I work for a billing company and this set of gastro docs never send office visit reports when they do screenings.
 
We do not schedule office visits for the patient either, if their only indicator is screening.All of the intake performed should be globalized to the procedure and done on the same date of service. In all there really is no reason for the proceedure to be seperated from the intake unless the patient insists they want to go over the procedure prior to the service at which time, ethically they should be notified their insurance may not cover that service. Overall it is commonly the desire of the individual provider to increase income by performing these unecessary service which we have instructed those providers within our group who wanted to do the same that they could be working toward an Audit, especially if Medicare is being billed for them.
 
tpontillo said:
Our doctors see patients for an office visit and bill V76.51 when they are going to have a screening colonoscopy. They are coming into the office because it is time for their colonoscopy. They do not have any symptoms but the doctor does go over their history and everything else. We bill the office with V76.51. We usually do get paid from the insurance company but one insurance company refuses to pay us. They are saying we are billing with the wrong CPT code. Does any else bill like this or are you billing differently?
Click to expand...

As anyone tried billing with V72.83 as the primary diagnosis? Our group was actually advised by a commercial payer to use this diagnosis as primary, (I used V76.51 as secondary) and we were paid when they denied, or applied V76.51 to deductible.
 
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