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E/M dx for screening colonoscopy

  1. #1
    Columbus, OH
    Default E/M dx for screening colonoscopy
    Medical Coding Books
    Scenerio: patient present to the office to schedule a screening colonscopy. The E/M was done 45 days before the actual scope was done. I have always used V76.51 to indicate that a screening colonoscopy is planned. The patient has no history or problems and this is just a routine over 50 screening. Medical Mutual is denying the E/M stating that it must be billed as a preventative visit CPT.

    If you don't use V76.51, what would indicate the 'need' for colonscopy. I don't agree that a preventative visit code is appropriate by a specialist. Any ideas??

  2. Default
    My doctors don't do E/M's for screenings and I think you are not supposed to bill for that. I could be wrong, but I think that is what has been said in earlier posts in this forum.


  3. #3
    Charlotte, NC
    Medicare bundles the OV prior to the actual screening into payment of the procedure. Most other payors do as well.

  4. #4
    agree. The visit prior to the screening is typically considered part of the procedure, regardless of how many days prior to the colonoscopy it is.

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