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E&M for Routine Colonoscopy-Help

  1. #1
    Default E&M for Routine Colonoscopy-Help
    Medical Coding Books
    I know this has been addressed before but hope to get solid advice on the following:
    Our office is in New York where direct access is not allowed, so when a PCP sends the patient to the gastro physician for a colonoscopy, the gastro must evaluate the patient and then he is the one to order the colonoscopy. So when the gastro does his E&M one week prior to the test and there is no injury or illness, just routine, can we bill the E&M? I believe we are unable to bill a visit without a problem or possible comorbidities to review for risk to meet key component guidelines. Any help is appreciated!!

  2. #2
    Boise, Idaho
    It depends on the carrier

  3. #3
    Yes, I'm seeking Medicare guidelines

  4. Default

    This article states that Medicare will not pay for an office visit with a screening. I don't know if this is a direct guideline, but with a name like codapedia who wouldn't trust it?


  5. #5
    Thank you for the direction. I will research further with codapedia and Medicare because I'm really not sure if "no direct access" come into play at all. I believe if it is strickly routine the provider can't bill for an E&M.

  6. #6
    Lauderdale Lakes
    I have a link from AGA regarding the screening exams

  7. #7
    This is extremely helpful - Thank you!!!

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