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Initial visit with surgeon for Screening Colonoscopy

  1. Default Initial visit with surgeon for Screening Colonoscopy
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    What would the proper way to bill a patient for an initial visit with the general surgeon if they are presenting as a referral for a screening Colonoscopy? We are getting denials from Medicare for the initial visit with the V76.51 code.. any suggestions? or do we need to be collecting up front for the visit?

  2. Default
    That is right. But may be they need a difinite primary first listed ; may be E/M service new patient / established ?!

  3. #3
    Fayetteville, NC
    If the only reason that the patient came to the office is for the set-up for the screening colon then you have no choice but to bill the V76.51. Medicare does not pay for the set-up visit when there are no indications (symptoms) and per Medicare you can bill the patient for this.
    I work for surgeons and we have struggled with this issue as well. Unfortunately for a screening set-up there is no easy answer
    Your office may want to start informing the patients who are there for screening colon set-ups that the visit will not be paid by Medicare and will be their responsibility.....

  4. Default
    Thanks for the clarification on this!

  5. #5
    We try to screen the appointments for this information. If they say it's for a screening we advise them right away that the visit isn't covered and then when they come in we have them sign an ABN for medicare patients. It had been an issue at our office before and the only reason we were able to bill the patient was because of the ABN. The patient called Medicare and complained about us and when Medicare called me, I explained we had an ABN, I faxed it to them and the patient paid the bill.

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