Results 1 to 7 of 7

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
    Charlotte, NC
    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
    It is for both screening and diagnostic. Why wouldn't it be paid?

  4. #4
    Charlotte, NC
    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 and search for CCS guidelines you'll find it.

  5. #5
    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
    Greeley, Colorado
    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
    Milwaukee WI
    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

Similar Threads

  1. Office Visit Prior to Colonoscopy
    By in forum Gastroenterology
    Replies: 3
    Last Post: 11-09-2015, 07:50 AM
  2. Office visit prior to colonoscopy?
    By ktews in forum Gastroenterology
    Replies: 0
    Last Post: 06-12-2015, 08:20 AM
  3. Office visit - I am hoping someone can provide
    By in forum Gastroenterology
    Replies: 5
    Last Post: 11-22-2013, 06:26 PM
  4. Office visit - It is my understanding
    By CPAGAN in forum Gastroenterology
    Replies: 1
    Last Post: 08-27-2013, 08:02 AM
  5. Office Visit Prior to Screening colonoscopy
    By Mklaubauf in forum Gastroenterology
    Replies: 2
    Last Post: 04-23-2009, 06:50 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.