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office visit for colon screening

  1. #1
    Question office visit for colon screening
    Medical Coding Books
    I have 2 different scenio's I am not sure how to bill out. Usually the E&M visit is bundled with the colonscopy if performed within 1 day prior to the colonscopy right?

    1st - New Patient was seen on Monday for a colonoscopy screening e&m visit. The new patient did not have the colonoscopy performed how do we bill this e&m visit?

    2nd - Established patient was seen on Friday for a colonoscopy screening E&M visit and didn't have a colonoscopy until 1 week later. Patient wasn't sure if they wanted it done and than decided to have it performed 1 week later. How do we bill for the office visit?

  2. #2
    Location
    Urbana, IL
    Posts
    23
    Default
    For the new patient 99201-99205 (healthy patient suggust 99202) and the established patient 99212-99215 (healthy patient suggest 99213).
    Regards!
    Dawn Peterson
    Coding Consultant/Billing and Coding Instructor
    Illinois, USA

  3. #3
    Smile
    Thank you so much!!!

  4. Default
    I have coded for general surgery. This has been my experience. If the visit was solely related to scheduling a screening colonoscopy we would bill this as a preventative services code. As you know Medicare will not cover a routine office visit; so our office chose to bill the patient directly and informed the patient this was a non-covered service. Patients with commercial coverage may have preventative care benefits, check with the carrier. Initial preventative care (65 y/o +) 99387 or established preventative care (65 y/o +) 99397typically this is what I used, the code depends on the age of the patient.

  5. #5
    Default office visits prior to screening colonoscopies
    Quote Originally Posted by annakilker View Post
    I have coded for general surgery. This has been my experience. If the visit was solely related to scheduling a screening colonoscopy we would bill this as a preventative services code. As you know Medicare will not cover a routine office visit; so our office chose to bill the patient directly and informed the patient this was a non-covered service. Patients with commercial coverage may have preventative care benefits, check with the carrier. Initial preventative care (65 y/o +) 99387 or established preventative care (65 y/o +) 99397typically this is what I used, the code depends on the age of the patient.
    I have been searching all morning and can't seem to find any clear cut guidelines from Medicare regarding billing an office visit prior to a screening colonoscopy. Our physicians will bill a level 1 office visit and put the screening diagnosis code, V76.51, on it. Medicare denies that of course. I am informing the office they need to tell the patient that this is a non-covered service. They usually see the patient a few days to a few weeks before the procedure is actually scheduled. Since the preventative care visits are so much more expensive, it would mean the patient would be out of pocket more than a lvl 1 requires but I am wondering - since preventatives are non covered (unless you use the new G code), you wouldn't need an ABN but if we continue to bill a lvl 1 office visit, would that mean we would need to get an ABN? Medicare denies the procedures as patient responsibility but I want to be sure that they don't come back and say they need to see an ABN if the patient calls to try and appeal it.

    My previous employer did not bill for office visits prior to screening colonoscopies so this is new to me to be working for a provider who does. Does anyone know of a link or a site that helps with what to bill or is it just provider choice?

    Thanks!

  6. #6
    Location
    Athens, OH
    Posts
    27
    Default
    In our general surgery office, we require an office visit prior to a colonoscopy in almost all cases. If the patient has commercial coverage and is just having a screening and absolutely no symptoms we use v76.51 and the preventative service code based on age. IF they are Medicare, we bill v76.51 and 99202 or 99212. We are in Ohio, and from my understanding we are one of the only states that Medicare will still pay for a visit prior to a colonoscopy.
    RBoggs CMA, CGSC **Bloom where you are planted**

  7. Default
    We are an office of three gastroenterologists. We do not see pts before a screening colonoscopy. The nurse goes over the pre-op questions and prep instructions by phone and information is sent by mail. Why do you see them? I cannot get paid by anyone for an EM service with a "V" code. Another note/question - Colonoscopies have zero global days. Why do you include an EM service?

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Check the Medicare manual on this as Medicare has stated that to see a patient prior to a scheduled procedure you cannot bill and office visit. The medical necessity for the procedure has already been determined and an examination performed for this purpose. I know this has been address in this forum many time and I believe Rebecca Woodward has posted the anual excerpt for this.

    Debra A. Mitchell, MSPH, CPC-H

  9. #9
    Default
    What if pt was sent for screening and talks about their constipation problems? How would you code that for billing?

  10. Default
    I have to agree with mitchellde and Trudy on this one. What are you evaulating and managing? It doesn't matter what day the patient was seen, if the patient is asymptomatic and was referred for a screening colonoscopy you cannot bill an E/M.

    AGA has some good articles on this including a coding faq at http://www.gastro.org/practice/pract.../coding-faqs#6
    "#6: How do I bill for a patient seen in our office prior to a screening colonoscopy with no GI symptoms and who is otherwise healthy?

    The visit prior to a screening colonoscopy for a healthy patient is not billable"

    Scenario 1:
    If patient comes in with no symptoms and they just need to have a screening for either preventive age 50+ once every 10 years or high risk (i.e. personal hx, family hx, etc), then you cannot bill an E/M. There is nothing to evaluate and manage. In most cases the patients are being sent by a PCP to have the procedure. The PCP already determined they needed it. All your MD is doing is going over their H&P, discussing risks & benfits, and scheduling. This is pre-op work weather the pateint follows through or not.

    Scenario 2:
    If patient comes in with sign and symptoms, your MD has to perform an evaluation and managent visit to determine the plan of care which includes the treatment and/or diagnostic studies (i.e. colonoscopy). You should bill with the appopriate E/M with the appropriate sign/symptom/diagnosis.

    Then we see patients that write "routine screening" on their intake form, get back to the physician (in your case nurse) and want to talk about the bleeding, diarrhea, and constipation they have been having. This requires a "time out." Someone needs to say to the patient, "I see you stated you were not having symptoms; however, I am happy to discuss your current signs/symptoms, but this will involve an office visit." If a visit takes place and the physician evaluates and manages signs/symptoms, he/she bills appropriately.

    In our practice at check in we give the patient a screening disclaimer which says that a discussion of signs and symptoms may result in an office visit and may not be considered preventive. Then they go to the scheduler. If the physician hands her a symptom diagnosis instead of screening, she hands the patient a piece of paper that states the patient is now aware he/she is undergoing a colonoscopy for xyz symptoms, not a screening.

    I hope this helps.

    Anna Barnes, CPC, CEMC, CGSCS

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