If a patient comes in to have a preop for a screening colonoscopy, this provider does not perform the colonoscopy, what would my secondary code be? No "reason" is given other than it's a preop for the colonoscopy. Isn't the Z12.11 for the actual encounter for the procedure?
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Wiki preop visit
- Thread starter Dfreddie
- Start date
Z01.81 Encounter for preprocedural examinations
Thank you. So, what you're saying is there doesn't "HAVE" to be a secondary diagnosis stating what the surgery is for?
There are times that a provider will do a preop and he will state a very nonspecific reason, like preop for right shoulder surgery. I'm being told to query for a specific reason and dx. And then provider says "look in the chart"
There are times that a provider will do a preop and he will state a very nonspecific reason, like preop for right shoulder surgery. I'm being told to query for a specific reason and dx. And then provider says "look in the chart"
You would code what the provider treated or saw the patient for that day. If they evaluated the condition that the patient is receiving surgery for (ie: colon cancer, etc) then you would list that dx code, but if they are just doing a pre-op clearance then you would bill for the pre-op visit and any other condition evaluated by the provider that day (ie: high blood pressure, etc).
Thank you! THAT clears up a lot of issues for me.
baroquecoder
Networker
Z01.818; Z12.11 seems inappropriate to justify an E/M visit.
I have a similar situation whereby the doc is billing for a preop to a screening colonoscopy.
No other conditions are addressed.
If we code it as above Z01.818 with Z12.11 being the reason, I do not believe that would satisfy the requirements of a separate and distinct E/M service.
In my opinion the pre-op for a zero-day procedure such as a screening colonoscopy is included in the procedure unless the patient's condition was such that further evaluation and management was necessary.
Section 1862(a)(1)(A) of the Social Security Act
"While the law specifically provides for a screening colonoscopy,
it does not also specifically provide for a separate screening visit
prior to the procedure. Thus, a pre-procedure visit performed on an
asymptomatic patient prior to a screening colonoscopy is not covered under current law.”
This is CMS, I suppose other payers might determine it differently?
I have a similar situation whereby the doc is billing for a preop to a screening colonoscopy.
No other conditions are addressed.
If we code it as above Z01.818 with Z12.11 being the reason, I do not believe that would satisfy the requirements of a separate and distinct E/M service.
In my opinion the pre-op for a zero-day procedure such as a screening colonoscopy is included in the procedure unless the patient's condition was such that further evaluation and management was necessary.
Section 1862(a)(1)(A) of the Social Security Act
"While the law specifically provides for a screening colonoscopy,
it does not also specifically provide for a separate screening visit
prior to the procedure. Thus, a pre-procedure visit performed on an
asymptomatic patient prior to a screening colonoscopy is not covered under current law.”
This is CMS, I suppose other payers might determine it differently?
Last edited:
The original question posted is that the physician performing the preop clearance examination is NOT the physician who will be performing the colonoscopy. Therefore, there is no global period since there is no procedure.
If in your situation, the preop exam is by the physician performing the surgery, then there is likely no distinct visit. If the plan to perform the colonoscopy was not previously established, and this visit was the decision to perform the procedure, then it would be billable. Based on your limited description, that does not seem to be the case.
If in your situation, the preop exam is by the physician performing the surgery, then there is likely no distinct visit. If the plan to perform the colonoscopy was not previously established, and this visit was the decision to perform the procedure, then it would be billable. Based on your limited description, that does not seem to be the case.