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office consult for screening scope

  1. #1
    Default office consult for screening scope
    Medical Coding Books
    is it appropriate to use dx code v76.41-special screening malignant neoplasm of colon with an outpt consultation code (99241-99245) when a patient has been referred for screening colonoscopy by her pcp?
    there are no risk factors, other than age, or medical complaints

    also, is it more appropriate to use a preventive counseling code from the 99401-99404 based on time as opposed to 99241-99245 as there is no exam being performed nor is there a medical diagnosis to support a need for specialists opinion-the patient was simply referred to my doc for a screening colonoscopy and he met the patient first to discuss risk factors, surgical risks and benefits, etc

    i am new to colorectal surgery/gastro and need some guidance on this particular issue

    any help is appreciated


  2. #2
    Milwaukee WI
    Default NOT a consult
    You are right ... if the patient was "referred for a colonoscopy" this is NOT a consult (advice or opinion was not requested).

    If the patient is new to your practice you may be able to bill a new patient office visit, depending on documentation. If the patient is known to your practice, the evaluation is part of the procedure.

    You say there is no exam? There has to be SOME exam for even the lowest level consult or new patient visit. UNLESS, you are billing based on time for counselling/coordination of care.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. Default
    1. You cannot bill a new or consult e/m if no exam is performed unless your MD documents that more than 50% of the total visit (time spent must be documented) was spent face to face with the patient on counseling.

    2. If a patient is sent strictly for a colon screening, what is your MD evaluating and managing? "There is an inherent understanding with any diagnostic and screening procedures that a basic history is taken and a brief exam is performed immediately before the procedure. However, this service is not separately billable." April 2004, Ask the coding expert, AGA
    AGA has a good article. Go to, click practice management on left, then click GI Coding Resources tab, Click Answers from the coding expert, then click April 2004 article.

    Hope this helps!

    Anna Barnes, CPC, CGSCS

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