Screening colon - incidental - Diarrhea and billing for biopsy of microscopic colitis


Largo, FL
Best answers
I work for an ASC. I have a doctor that frequently does colon screenings and adds in incidental - diarrhea (probably things she's told a half hour before the procedure). During the screening she will do a biopsy on what she describes as a colon that appears normal. She does it to check for microscopic colitis. This points me back to the reason the patient was NOT there; the incidental diarrhea. So what she says she did:

45385 - PT (found a polyp)
45380 - PT 59

Thus far I have just scratched that second CPT and not billed it because that is not why the patient was here. I had another biller tell me "You can bill for that. I just put in a diagnosis of colitis" I am not comfortable with this as this patient was not actually diagnosed with colitis as of yet and the colon "appeared normal". Not to mention that the patient is doing a colon screening and there was no inflammation.

What are your thoughts?
This is the other argument we have. When the doc puts on an "incidental" does it then become diagnostic? I thought so, but then I see opinions all over the board on this. I suppose the doc has to include what the patient told them just before the screening. Unfortunately, what will happen in this scenario is that I would get a phone call from a very irate patient saying that they were supposed to get a free screening. I have Googled the heck out of this and can't find solid evidence of how something like this is handled (incidentals).