AAPC - Back to school
Results 1 to 3 of 3

Thread: office consult for screening scope

  1. #1
    Join Date
    Apr 2007

    Default office consult for screening scope

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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. #3


    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 www.gastro.org, 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

Similar Threads

  1. Replies: 1
    Last Post: 01-03-2013, 10:05 AM
  2. Screening C-Scope VS/ Removal of polyp
    By carol52 in forum General Surgery
    Replies: 2
    Last Post: 09-26-2011, 07:32 AM
  3. Consult with Scope
    By pinnaclephyserv in forum ENT/Otolaryngology
    Replies: 3
    Last Post: 06-12-2010, 08:36 AM
  4. Can I charge an office visit and a scope?
    By nsclark2 in forum ENT/Otolaryngology
    Replies: 1
    Last Post: 04-07-2009, 10:34 AM
  5. C-Scope Screening
    By PaulaW in forum General Surgery
    Replies: 1
    Last Post: 09-15-2008, 09:01 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.