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Screening Office Visits Indications for Colonoscopy

  1. Default Screening Office Visits Indications for Colonoscopy
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    We see patients for a preliminary office visit before colonoscopies. I am trying to get my doctor to stop listing other diagnosis codes with V76.51 but he doesn't understand why i am asking him to do this. I have given him exerpts from books post from this website and he still does not understand why you can not list diagnosis codes such as 569.3 with V76.51 (this is for the office visit only - i realize that you can list those types of codes once the procedure has been performed). I have not found anything anywhere that actually states what codes may be used in conjunction with V76.51 in order for the office visit to be a true screening visit. He also lists constipation and diverticulosis at times with V76.51. I would assume that diverticulosis would be ok to list (because it is usually used almost like a hx of code) but i am not sure about constipation. The literal defenition of V76.51 is absence of symptoms but when i mention other codes he always says "that is not an idication for colonoscopy so it is ok to bill them together". What ends up happening to the patient though, when this is the case, is the insurance company ends up choosing which ever code would be to their benefit and the patient is the one who ends up paying in the end. Any help or comments on this would be appreciated. THANKS!

  2. #2
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    I would like to get more information too. What I found is that V76.51 is for screening malignan neoplasms on Colon, used for a colonoscopy as prevent exam, it means with no symptoms. Usually used as first diagnostic for screening.
    Also V Screening codes could be used as second diag code when the screening is done during an office visit for a different reason.
    However; in this case V76.51 is for colon screaning, could have be done a digital exam? and that is why, Dr. is billing V76.51? In the other way, i would say that Dr. needs to understand that this code is for colon screanning and it is needed the procedure done in order to use this diag. v76.51.
    Please correct me if I m wrong. I m new and studying for the exam. Thank you.

    Quote Originally Posted by jessicamariposa View Post
    We see patients for a preliminary office visit before $colonoscopies. I am trying to get my doctor to stop listing other diagnosis codes with V76.51 but he doesn't understand why i am asking him to do this. I have given him exerpts from books post from this website and he still does not understand why you can not list diagnosis codes such as 569.3 with V76.51 (this is for the office visit only - i realize that you can list those types of codes once the procedure has been performed). I have not found anything anywhere that actually states what codes may be used in conjunction with V76.51 in order for the office visit to be a true screening visit. He also lists constipation and diverticulosis at times with V76.51. I would assume that diverticulosis would be ok to list (because it is usually used almost like a hx of code) but i am not sure about constipation. The literal defenition of V76.51 is absence of symptoms but when i mention other codes he always says "that is not an idication for colonoscopy so it is ok to bill them together". What ends up happening to the patient though, when this is the case, is the insurance company ends up choosing which ever code would be to their benefit and the patient is the one who ends up paying in the end. Any help or comments on this would be appreciated. THANKS!

  3. #3
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    Columbia, MO
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    This posted by the UCDHS Compliance office:
    It is also important to understand that a referral for a screening colonoscopy does not constitute a consultation. A consultation is a distinguished from an office visit because it is provided by a physician whose opinion or advise regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. If the primary physician is referring their patient for a screening colonoscopy, the need for a screening colonoscopy was already established and there is no opinion being sought.
    When a patient is referred for a screening colonoscopy, the term “screening” indicates that the patient does not have signs or symptoms that support a diagnostic colonoscopy. Although the GI physician may wish to see and evaluate the patient prior to a screening colonoscopy, the evaluation and management visit is generally not separately billable.

    This is from CMS:
    Evaluation and Management Visit prior to Screening Colonoscopy
    Q. Can a provider bill an E&M visit if a beneficiary is referred for a screening colonoscopy?
    A. A provider preparing to perform a screening colonoscopy cannot also bill for a pre-procedure visit to determine the suitability of the patient for the colonoscopy. There E/M services, to include consultations, are not separately payable. While the law specifically provides for a screening colonoscopy, it does not also specifically provide a separate screening visit prior to the procedure. Although no separate payment can be made for these visits currently, the fee schedule payment for all procedures, including colonoscopy, contains payment for the usual pre-procedure work associated with it. This reflects the principle that each procedure has an evaluative component.

    Debra A. Mitchell, MSPH, CPC-H

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