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Colposcopy AND Office Visit??

  1. #1
    Greater Pittsburgh Chapter
    Default Colposcopy AND Office Visit??
    Medical Coding Books
    I started a new job as a coder for a gynecologist. I am being told completely different things from other coders/billers so I need some opinions.

    Ex.: A patient comes in for their annual exam and the doctor collects a pap smear. The pap smear comes back abnormal. So, the patient is scheduled for a follow up appointment. During the follow up appointment, a limited exam is done and then the doctor does a colposcopy. The doctor is charging the colposcopy and an E/M code since she did an exam on the patient before the procedure.

    In my opinion, unless the patient has something else that has nothing to do with an abnormal pap smear (like if the patient would say, "I felt a lump on my breast last night in the shower. Could you check it while I'm here?"). In my opinion, the exam done on the patient pertains to the colposcopy so it cannot be charged.

    Now, I should mention that this particular doctor seems to do colposcopy's on patients a lot when they have an abnormal pap smear. And the documentation from the follow-up visit does not say anything about discussing the colposcopy. She just documents that she did a colposcopy that day under the diagnosis. She also draws a picture of what was done during the colposcopy and scans it into the EMR as documentation.

    What are everyone's thoughts?? Charge the 57454 by itself or can we charge 57454, 9921X-25.

  2. #2
    I agree with you. If the patient is brought back specifically for the procedure secondary to an abnormal pap, and no other significant, separately identifiable problem is documented, then the use of an E/M code and the -25 modifier would not be appropriate. Additionally, in my mind, the patient was scheduled for a procedure, not a "follow-up visit", but that's just my OCD kicking in )

  3. #3
    I don't work in gyn, but I also would be extremely reluctant to file an office visit and the colposcopy.

    I don't think that by doing a brief exam you have enough to prove a separately identifiable office visit and the procedure. The limited exam would be included in the payment for the procedure. If the doc thinks it is medically necessary to do a colposcopy that's one thing, but another office visit...

    I agree a breast lump, would warrant billing an exam separate from the procedure.

    Maybe you could pull the guidelines for mod 25 to show your fellow coders? Sounds to me like you know/are following the guidelines!

  4. #4
    Greater Pittsburgh Chapter
    PVAzCPC - you are correct in saying that this is not a follow-up appointment. I wrote it this way on purpose though...these patients are being scheduled as a follow-up appointment and some people are arguing that since the doctor didn't decide to do the colposcopy until the patient was here for the "follow-up" it warrants the E/M code. This is becoming a problem because the front office doesn't realize when they look at the schedule that the patient is going to be having a procedure and they're collecting a co-pay.

    Thank you for your help!

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