OH Trina, I feel your pain.
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. AGA has very good articles on this.
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).
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 the are undergoing a colonoscopy for xyz symptoms, not a screening.
I hope this helps.
Anna Barnes, CPC, CEMC, CGSCS
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