visit for screening colonoscopy no symptoms.

kbarron

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pt is coming in w/o cc. Wants to have screening colonoscopy. Shouldn't 99401-99402 be used as there are no symptoms. Insurance is denying office visit 99203 w/dx V76.51 as sick code with routine dx code. Colonoscopy was done 12 days later w/o modifier.I believe that we should use the counseling codes with V76.50 as dx. and as far as the colonoscopy goes there should be a 33 modifier as this is United Health Care, Any help is greatly appreciated.:)
 

tpontillo

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If you are talking about the 99401-99409, I have never used these codes. I have always assumed these to be for behavior health.

As far as the insurance paying on the office visit codes, some insurance's will pay and some wont. Patients should be made aware of this when they come in for these visits.
 

acbarnes

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PER AGA (American Gastroenterological Association): http://www.gastro.org/practice/practice-management/coding-faqs#6

How do I bill for a patient seen in our office prior to a screening colonoscopy with no GI symptoms and who is otherwise healthy?

The visit prior to a screening colonoscopy for a healthy patient is not billable.

THe AGA website has several colonoscopy coding FAQs that are very helpful. I am ahppy to go into more depth is you would like to contact me at 678-704-8141, abarnes@atlantacolon.com.


Anna Barnes, CPC, CEMC
Atlanta Colon and Rectal Surgery, PA
 
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Hi All,

You certainly can bill the 994 series for a visit where the patient presents for a colonoscopy screening. The GI is going over the risks and benefits of the procedure as well as how to prep. I researched these codes years back as I was getting the same denial using traditional consultation and E&M coding and once we began using the 99403, he was getting paid for them. This is preventative counseling that can be used for a very broad range of counseling such as weight loss, contraception, mental health, etc.

Thank you,
Paula Lincoln CPC
 
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