Positive Feccal Occult test and pre-screening visit

deeva456

Expert
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276
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0
A patient has a positive fecal occult blood test (FOBT) and is referred to GI for a colonoscopy. Can the GI physician bill for a pre-screening visit? In many cases the only symptom may be a positive FOBT. This question has come up several times in the past few weeks and am having trouble finding a definite answer or even a generalized answer

Thanks!!

Dolores
 

julesmit@live.com

New
Local Chapter Officer
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4
Location
Hilo, HI
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If you performed the test in office, it is billable. R19.5 can be used for dx code or K92.1. Note that if you are trying to close a quality measure on this patient, in office FOBT do not count. Just an FYI
 

surfergirl

Networker
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39
Location
Spring Lake, NJ
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Hi,
When the patient comes to the GI he already has the Positive test so the GI Would include that as DX. The colon could be screening. In my opinion.
 

AthensCoder

Networker
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78
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In my opinion, the patient is now symptomatic and the need for the colon is to determine the source of the bleeding. Thus this would not be a screening visit,but a diagnostic visit.

To qualify as a screening the patient must be asymptomatic with no complaints/issues.
 

clarkmegan

Networker
Local Chapter Officer
Messages
49
Location
Newport News
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I agree with Sonja. The FOBT was the screening, which has already been billed as such. If you try to bill a screening, you should get a denial. Once the patient has a positive finding, he/she is no longer asymptomatic and the colonoscopy is diagnostic. Yes, you can bill the office visit, but not as a "pre-screening" visit, aka S0285.
 
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