Wiki Preoperative exam with Colonoscopy

[mworm2018]

I work for a private Family Practice Clinic. We have had patients that come to have a preoperative exam because they are scheduled for a colonoscopy. These preoperative exams are ALWAYS done days before the surgery, NEVER on the same day. Sometimes our physicians perform the surgery and other times it is performed by outside general surgeons. For years we as a clinic have billed out Z01.818 and Z12.11 with 99214. This was being done because the general surgeons would request that they have a preoperative exam done before they would perform the surgery. We recently had a call from a patient mad because their insurance company (BCBS) said that their colonoscopy would be paid 100%. Are you allowed to billed Z01.818 and Z12.11 or is the preoperative exam included in the global charge for the colonoscopy?

 

[csperoni]

If you are not the office performing the colonoscopy, there is no way that global applies. In those situations, you are probably providing medical clearance.
If you are the practice performing the colonoscopy, and have already decided to perform the colonoscopy, then this is global.

 

[mworm2018]

We are billing it with an E/M code is this still correct or are we needing to change it to a preventative code? Would it make a difference if we used the preventative CPT code instead?

 

[csperoni]

It should be E/M, not preventative for medical clearance, unless the physician and documentation really shows a well visit. I would doubt it does. The visit was to evaluate the patient to determine if he/she was able to undergo the procedure. In the situation you describe, I assume the patient is complaining about her copay/deductible/co-insurance for her medical clearance as the insurance told her the colonoscopy by another physician is covered 100%??? While the colonoscopy may be covered at 100%, that does not mean her visit to your office is covered at 100%.

 

[mworm2018]

Thank you for all your help! We greatly appreciate it!