Pre Colo visit and using preventative E&M

cas614

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Is it appropriate to use any of the preventative evaluation and management codes like 99381 etc for a pre colonoscopy visit, when a patient presents with no symptoms at all and this all pertains to a screening colonoscopy based on the patients age?
 

Pam Brooks

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I would not. The preventive codes are used to report annual preventive exams, not for a pre-procedural visit. These are meant to report comprehensive preventive and risk-reduction evaluations of the patient, not for single-system issues or situations. (read the code description guidelines....they are very helpful) Further, if you bill out the preventive exam, and then later your patient goes to the PCP for their annual well visit, it will be denied (or vice versa).
 

cas614

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Thank you so much, exactly what I thought. Which brings me to my next question, should we be doing a pre-colo visit and charging a consult or new patient code etc if it is just a visit for the colonoscopy?
 

CodingKing

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If its just a visit for a colonoscopy, then no E&M it's standard pre-op (ie decision to perform has already been made). I did hear of some new codes for routine colonoscopy consult (cant remember the code) but don't know if they are covered by any payers yet.
 

cas614

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Thank you for your great advice! One more thing, I know how my doctors will respond to that. They will say, but I have not actually decided to do the colonoscopy yet and that they have to do a complete exam and history to do the procedure, any advice on how to answer this?
 

agibb1022

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Thank you for your great advice! One more thing, I know how my doctors will respond to that. They will say, but I have not actually decided to do the colonoscopy yet and that they have to do a complete exam and history to do the procedure, any advice on how to answer this?

Typically patients are seen by their PCP for a routine visit and then the PCP refers them to the GI dr for a screening colonoscopy. The records from the PCP should suffice for complete exam and history if it truly is just a routine screening without symptoms. The PCP may also indicate in the referral that the patient has a family history of CRC or another risk factor, but even if they don't, gathering just that piece of information does not justify an E/M visit prior.

HTH!
 
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