question on colonoscopy/egd

debaloia

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One of the docs says he can bill a 99234 which is an observation code when he bills for colonscopy or and egd on the sameday. I state that H&P etc would be included in global for outpatient colonoscopy or egd. He states that since there are no global days for either procedure he can bill the 99234. What are your thoughts? Does anyone know of where I can find in writing what is included in colonscopies and EGD? We are in PA. Any help is appreciated. thanks!
 

mad_one80

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i use customCoder at my office to validate the cpt's billed and it appears that your doctor is right....the 99234 can be billed on the same day as a colonoscopy or egd...as long as you use a -25 or -57 modifer on the 99234.
 

debaloia

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Thank you for your reply. We do get paid on it by some carriers. But since it is an observation code and doctor is using it for H&P I thought it should not be billed. Would you agree? Thanks again for your reply. I appreciate the input!
 

mkj2486

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I would think that your patient has to be admitted to Observation to use this code. Your question looks like the Doc wants to use the code for a regularly scheduled colonoscopy, and in that situation, no you cannot code the 99234. You can only code an E/M if there is a problem involved before the colonoscopy and it needs evaluating. Example, the patient comes in and now has rectal bleeding. In this case the colonoscopy has changed from a screening and is now a diagnostic. You can code an E/M before the colonoscopy only if it is for a diagnostic reason, and the doctor hasn't evaluated the patient previously....the patient didn't come to the office prior to the colonoscopy for the same reason the colonoscopy is being done. An E/M cannot be charged for a screening colonoscopy at all, with out medical necessity.
 

mkj2486

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I should clarify....you would have to have the proper documentation stating why it was medically necessary for the physician to perform an E/M prior to doing the colonoscopy. Obviously, if the patient comes in for the colonoscopy with a minor complaint, you wouldn't need to perform an E/M, because they were having the colonoscopy anyway. What I had meant to say is if they present with a major problem and need further evaluation because it had not been addressed before, then you could also charge the E/M....with the proper documentation.
 

pamtienter

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I don't think the observation codes are appropriate either. They do need to be admitted to observation and Medicare has specific criteria (whether or not other payers follow):
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5791.pdf
The colonoscopy, etc codes have a 000 global day assignment so they are considered "minor" procedures and an E/M on the same day would be included. The 25 modifier would be required on the E/M if it's billed the same day so the 25 modifier definition is good to show them to define "separately identifiable". Here's a good article with procedures and E/M info explaining what is included in the procedure.
http://www.aafp.org/fpm/20041000/21unde.html
 
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