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Colonoscopy Coding

  1. Question Colonoscopy Coding
    Medical Coding Books
    I really seem to be struggling with patients that come in for screening colonoscopys.
    The patient comes in for a screening, and is a new patient referred by their family physician. According to Medicare guidelines we cannot bill for that pre-op-even though our physician has never seen that patient before-unless patient has a problem that is revealed during that exam, or is on Coumadin. So if our doctor sees that patient prior to the surgery-which he does-it is coded as a freebie or post op charge. Patient then has their colonoscopy and our doctor brings the patient back in to give them their results.Since colonoscopys have a zero global period-can we bill them for that post op visit?
    Or is that considered part of the global surgical package?
    Thanks...Kathy Albert,CPC

  2. #2
    Pensacola, Florida
    You are correct. You can't bill Medicare for a screening pre-op visit. Our doctors don't see referred patients before a screening colon. (Probably because they won't get paid). The staff does a pre-op questionnaire, then on the day of the colon, the Dr. does an H&P. The patient gets results same day, unless there is pathology, in which case they send the patient a letter with the results. Now, if there happen to be other findings, and the Dr. wants to see the patient for a follow-up visit to further address those findings, then we bill the follow up visit with their diagnosis as the reason for the visit. I don't think you can bill Medicare for an office visit solely for the purpose of giving the patient results of a screening colonoscopy. Hope this helps.
    Bridgette Martin LPN, CPC, CEMC, CGIC

  3. Smile
    Thanks so much. If you go online or even our web-site-some say to bill for them-and I know thats not right. We have doctors who insist that they can charge for a pre-op-and when you try to explain that you cant-then they say well if theres no global-then I should be able to charge for the post op? So -bottom line-you cannot bill for a pre-op unless there is a problem or patient is on coumadin. You cant bill for a post-op unless something was found? Even say diverticulosis? You have been a tremendous help. Our doctor wants to bill pre and post op. I will show him this. Thanks so much.
    Kathy Albert,CPC.

  4. #4
    Pensacola, Florida
    I don't have anything in writing to back this up, but I would think that if the sole reason to bring the patient back was to tell them they had diverticulosis - that they aren't going to do anything about - I don't know about that. There are other forum posts about pre and post-op visits when patients are on Coumadin, but to be honest, I don't follow those. I also don't know about commercial carriers. Some may allow it. You may want to go back to those older forum posts to see if someone happened to mention a link to an article or processing manual that addressed this issue. Hopefully, you'll also get some other responses to this post. If your Dr is a member, another option would be to send an email to the AGA's coding hotline. Sometimes I think I know the right answer because that's how "I've always done it" or what I've been told, only to find out I'm wrong!
    They may have loads of experience in this area and shed things in a different light.
    Bridgette Martin LPN, CPC, CEMC, CGIC

  5. Default
    Thanks for responding back!
    Kathy Albert,CPC

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