Wiki Pre-Op Visit for Screening Colonoscopy


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My director wants to bill for preop visit for patients who are coming in for screening colonoscopies. Instead of the nurse doing the H&P over the phone, the patient would come in and see the nurse practitioner. Could we bill a low level E&M code for this?
Visit Prior to Screening Colonoscopy
Friday, January 01, 2016
As of December 27, 2015, the ACA (Affordable Care Act) was revised to include visits prior to screening
colonoscopies. If the patient is in a non-grandfathered plan which means they are in a health care
policy with effective date after September 23, 2010, they have to follow the ACA guidelines. Medicare
and Medicare replacement plans do not follow ACA guidelines so the visit prior to screening is not
separately payable. For commercial payers, you need to access their websites and/or call them and
follow their guidelines. For example, UHC has already something posted on their website that indicates
that they will cover 99201-99205 and 99211-99215 with a diagnosis of Z12.11, Z12.10, Z80.0 and
Z83.71 as a primary diagnosis, effective January 1, 2016.