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office visit prior to colonoscopy

  1. #1
    Default office visit prior to colonoscopy
    Medical Coding Books
    It is okay for a provider to bill an office visit prior to a colonoscopy as long as it is not on the day of the colonoscopy, correct? Do your providers usually see a patient prior to a routine colonoscopy? Do they charge for the visit?

  2. #2
    Location
    Charlotte, NC
    Posts
    534
    Default
    Is it for a screening colon?

    Either way you can bill for the OV, just probably won't get paid. It's why so many practices are going to an open-access set-up for CCS.

  3. #3
    Default
    It is for both screening and diagnostic. Why wouldn't it be paid?

  4. #4
    Location
    Charlotte, NC
    Posts
    534
    Default
    If it's a screening, Medicare (and others typically follow) states the "cost of the OV is factored into the pymnt of the screening procedure".

    However, if the pt is sent for a problem (diagnsotic) originally, then yes, the OV would and should be covered.

    I'm not sure of the actual link to the CMS guidlines but if you go to cms.gov and search for CCS guidelines you'll find it.

  5. #5
    Smile
    Bill the office visit for the signs and symptoms the patient is having that the physician needs to manage, using those diagnosis codes. Attach the -25 modifier to it if the procedure is done the same day. Then code the procedure with the diagnoses representing the findings. Both should be paid. However, if the physician is just having the patient come in to discuss the procedure prior to it being done, and not actively managing a problem, then the office visit wouldn't be billable on the same day. Hope this helps!

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    If the patient is being seen prior to a screening colonoscopy (aka no symptoms), no one is going to pay an E/M visit with V76.51 as the dx.

    Torilinne is absolutely correct.
    Lisa Bledsoe, CPC, CPMA

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default Rvu
    If the patient is coming to your office to have a colonoscopy you should bill ONLY the procedure.

    Every procedure - even a colonoscopy - includes some RVU for the pre-procedural evaluation. You are ALREADY being paid for this eval of patient when you are paid for the procedure.

    If the patient is coming to your office with a complaint (symptoms of bleeding, pain, constipation, whatever ...) and as a result of your evaluation of the patient you decide to perform an additional diagnositic test/procedure (like a colonoscopy), then you can code the office visit (new or established, as appropriate). And if you perform the diagnostic test the same day, you'd add a -25 modifier to the E/M (but since colonoscopy requires a day of prep, I can't see that happening).

    Having the patient come in a day or two early for an "eval" when they called to schedule a screening colonoscopy does NOT equal a billable service.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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