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Consult and colonoscopy

  1. Smile Consult and colonoscopy
    Medical Coding Books

    If a patient is admited to Pulmonary service and Gastroenterology is called to do a colonoscopy. Can they bill for a consult to evaluated the patient and bill for the colonoscopy on the dame day?

  2. #2
    Greeley, Colorado
    If the Gastroenterologist was asked specifically to perform a colonoscopy then I would say no consult. If s/he was asked to consult for a specific GI issue and decided that a colonoscopy was required for diagnostic purposes, then most likely yes.
    Lisa Bledsoe, CPC, CPMA

  3. Smile
    Thanks a bunch, this is my first time on the forum and this is really helpful.

  4. #4
    Greeley, Colorado
    Welcome to the forum!
    Lisa Bledsoe, CPC, CPMA

  5. Default
    I agree with Lisa.


  6. #6
    Default consult and colonoscopy
    We are having a hard time convincing our GI docs that a screening colonoscopy requested by an internal med doc is just that a request for a screening. The GI docs tell me, "I can find something wrong with any patient and bill a consult." Our contention is that is not what the IM doc asked for. The reply is that "those doctors do not know what they want." I need some hard cold facts about this and where to find definitive information to prove to these guys that they cannot bill for a consult if all that was requested is a screening colonoscopy. Any help woyld be greatly appreciated. Lynn Kimsey, CPC-I, CPC-E/M

  7. #7
    Charlotte, NC
    I would direct them to the AMA CPT book. There should be a consult guideline in there.
    Last edited by coachlang3; 01-06-2009 at 03:23 AM.

  8. #8
    Several years back, the ACG posed this question to CMS and it was answered through PRIT (Physician Regulatory Issues Team) ( stating that normally a pre-procedure E&M would be covered for colonoscopy, but the screening colonoscopy is a special benefit created by congress, and the pre-procedure service before screening colonoscopy was not included in the legislation.

    I can understand the physicians' sides of this issue. Many patients actually end up with signs and/or symptoms when seen prior to a screening colonoscopy. There are a multitude of issues involved with screening colonoscopy that are difficult to deal with.
    Jenny Berkshire, CPC, CEMC, CGIC

  9. #9
    Smile Consult and colonoscopy
    Thanks, Jenny for that info. Lynn Kimsey

  10. #10
    Milwaukee WI
    Default Intent of requesting physician
    We just got a newsletter from our Medicare carrier (WPS) with a "consultation Q&A." Here's the link:

    Over and over again they repeat that it is the intent of the originating physician that determines whether you have a consultation, not the outcome of the visit. So if the original physician is asking for your advice on a GI problem, and in evaluating the patient you decide you need to perform a colonoscopy, then you still have a consult. But if the intent of the original physician is to have you perform the colonoscopy (because s/he doesn't do that), then you do not have a consult.

    However, if this is a new patient to your specialist, you may have a new patient visit (or a subsequent hospital visit if this was an inpatient).

    F Tessa Bartels, CPC, CEMC

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