Treament options or number of diagnosis

[DawnKuhl77]

Just for clarification, if a patient with no symptoms presents for a consult for screening colonoscopy, would this be scored as self-limited or minor, or new problem additional work-up planned. There is some disagreement in our office about this. Or if anyone could point me to a source to be able to have concrete rules about screening consults that would be great too. Thank you!

 

[thomas7331]

This has been discussed a number of times on this forum so I'd recommend reviewing some of the older posts and discussion threads. There is not universal agreement on this, but in my opinion, because a screening colonoscopy is a preventive service, a consultation or other E&M office visit code that is for reporting the evaluation and management of a problem is not appropriate. All of those codes require a chief complaint, and there is none for a screening and so by extension, as you point out, no way to properly score diagnosis points in order to support an E&M level.

Unless there is a symptom, problem, or other comorbidity that requires physician evaluation prior to the procedure, the medical necessity of this visit is not supported. Under global surgery rules, the initial evaluation and decision to perform a colonoscopy is a component of the global surgical payment and should not be billed separately. Many GI practices screen patients by phone interview prior to the visit and do not schedule a separate face-to-face visit with the physician unless that interview identifies a problem or concern that needs to be addressed by the physician in advance. A separate visit done solely for the convenience of the patient or provider is, by most definitions, not medically necessary.

Some payers do offer a preventive benefit for a patient to have a consultation with the physician prior to a colonoscopy, in which case that service may be billed with HCPCS code S0285, or with whatever code that payer designates in their policies should be submitted.