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Thread: Question about medicare guidelines for colonoscopy

  1. #1
    Join Date
    Apr 2007
    Lehigh Valley

    Default Question about medicare guidelines for colonoscopy

    AAPC: Back to School
    Hello all,

    I tried researching this in the forums, but could not find a definitive answer to my question.

    I understand that Medicare will not pay for E/M visit prior to screening colonoscopy, either the day before or day of the procedure. I have a patient who was seen in the office on 9/1 and will have a colonoscopy in 12/09??? He did have a defibrillator placed in 9/09 (new history to my doc) and needs cardiac clearance. Is this E/M billable???

    Also, for all Medicare pts with screening colonoscopy E/Ms are they not billable no matter when the colonoscopy will be performed?????

    So confused!!!

    Thanks for the help.

  2. #2
    Join Date
    Apr 2007
    Charlotte, NC


    Actually, if the E/M visit is not related to the screening, you should be covered. Is there a reason the screening is in Dec? Was it part of the plan and assessment? Is the reason the pt came to your doc a screening?

    If your doc was just seeing the pt prior to a screening to gauge the pt's health for a screening, then no, it's not covered. That's why offices need to get ABN's.

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