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Thread: E/M and Colonoscopy

  1. #1

    Default E/M and Colonoscopy

    AAPC: Back to School
    This might be a little odd but since I have been doing coding I always look at my mom's EOBs and Dr Bills for her. Well she went into the hospital for an outpatient colonoscopy; and the Dr also billed a 99213 with it. I asked her if he talked to her prior or after the procedure and she said , " yes for about 10 minutes prior to the procedure, but it was regarding about what he was going to be doing for the colonscopy."
    1) I do not think he can bill an outpatient E/M the same day she done the conoscopy. Does anyone else think this?

    2) If it isn't possbile he bills both where can I find proof so I can present it to the Dr or to the insurance company.

    I'm concerned because I do not want my mom to pay this bill if it was coded incorrectly.

    The Dr's at my work never charge an office visit with the colonscopy done on the same day. * unless it was inpatient *

    Hopefully someone can help me out
    Last edited by VRcoder29; 07-10-2008 at 12:44 PM.

  2. #2
    Join Date
    Apr 2007


    sounds like fraud to me. He should not be billing out for an OV its global to the surgery. Did the carrier actually pay it?

  3. #3


    funny thing, i just looked up on cranware and this is what it says

    99213 & 45385

    Code 1 & 2 procedures cannot reasonably be performed together due to the procedure definitions or the anatomic considerations. In the case that both codes 1 and 2 are performed on the same beneficiary on the same date and by the same provider, only code 1 ( 99213 ) will be paid. Code 1*99213* represents the procedure of the lesser work RVU of the two procedures- this is designed to encourage correct coding pratices.

    So basically as far as I can tell the Dr has only be reimbursed for the 99213 only on my mom's EOBs, the Colonoscopy has not went through yet. Yes, Anthem BCBS is her carrier and they did pay for the 99213.

  4. #4
    Join Date
    Apr 2007
    Duluth, Minnesota


    I'd put in a call - wouldn't pay the office visit either - only the colonoscopy should have ben charged. Even if the doc had done a complete pre-op "that day" IF it was done "that day" - it won't be paid, shouldn't be billed.
    (I watch my mom & dads EOB's too)
    Donna, CPC, CPC-H

  5. #5
    Join Date
    Apr 2007


    A pre-op visit is almost impossible in this scenario, the patient was already administered the prescription and/or provided the prep at minimum two days prior to the procedure.

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