Pre op

samyjm13

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A patient was referred for a colon cancer screening. With no other dx, would I code the V72.83 and V76.51 and a 99203 E/M. Or can I even code a pre-op before the screening. The Dr. did a pretty good exam. Is this right or am I off base? this is not a medicare patient.

Thanks,
Jeanne
 
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Lujanwj

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Unfortunately, there isn't clear cut answer aside from there's Pre-Op E/M reimbursed with the screening codes (0 day global or XXX - included in another service). I'd suggested billing an E/M only if you can justify Mod -25 as separate and distinct; in addition, I'd make sure you can justify medical necessity for doing such an exam. If you can justify both, bill it. If not, well, don't.

I understand it's not Medicare but I've added the link for CMS' Preventive Services manual(too big to attach) as it might help. It doesn't directly answer your question for colonoscopies but answers it for other Preventive Services which should have the same policy.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads//mps_guide_web-061305.pdf
 
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