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Thread: Office Visit Prior to Screening colonoscopy

  1. #1

    Default Office Visit Prior to Screening colonoscopy

    AAPC: Back to School
    If the patient has not had a recent history and physical by their family physician we ask them to come in to the office prior to the colonoscopy. This is usually done a week or two before the procedure(not on the same day as the procedure), This is done to check out their heart and lungs and make sure that there is no problems undergoing anesthesia. The physicians do a very well documented exam and the dictation reflects it. Our only diagnosis is the screening V76.51. Will Medicare pay for an E/M with this diagnosis?

    Any thoughts, please

  2. #2


    as a Medicare Biller for a large Gastro-entro. group, I can attest Medicare will NOT pay for the office visit. As long as a V code is prime it will be applied to patient responsibility.

    Does anyone else have any suggestions??


  3. #3
    Join Date
    Apr 2007
    Swainsboro/Statesboro, GA

    Default Same frustrating question!

    I have been asking and researching this very topic and I have found differencing opinions!

    There is another thread here, (I think it's titled "Consult and Colonoscopy") with a lot of good info. I've also posted this question to other professions, but again, I get different opinions.

    At this point in my research, I am at the conclusion that Medicare (and I have heard the same goes for other payers as well) does not cover an office visit where the intent is to evaluate for a screening colonoscopy. Since this is a noncovered service, but could be in some situations, I would recommend getting an ABN signed on Medicare patients.

    I am hopeful that this issue might be commented on to CMS during the commenting period for the 2010 Proposed Rule for Physicians. (That may not be the exact term! I deal with the OPPS side, but I know there is a proposed rule for physicians!) If it is in the proposed rule, the public can comment on it. I know the American College of Gastroenterology brought this up as far back as 2002.

    I would love to hear more discussion on this topic! I just can't let it go!

    Freda Brinson
    Savannah, GA

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