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Colonoscopy Post Op Billing

Debra Posted Thu 25th of September, 2014 10:00:20 AM

I am new to billing general surgery. I finally understand the guidelines for the billing/not billing the pre-op E/M prior to the colonoscopy.

Am I able to bill for the post-op visit? There is no global days. Dr. found polyp, wants to see him again in 5 years?

If I can bill the post-op, how do I code it in the post-op period?

SuperCoder Answered Thu 25th of September, 2014 10:18:53 AM

Thanks for your question. Just as a clarification, your doctor wants to see the patient for a follow up after the procedure, correct? If you are referring to a post-op E/M visit, then yes you are able to bill for those services. You would use an E/M code from 99211-99215 series. You would select a code based on on time or the 3 components (history, exam, and medical decision making).

At the time of the next colonoscopy, the patient will be considered high risk due to the history of colon polyps. You would then code the procedure using diagnosis code V12.72; personal history of colon polyps. See the attached link for additional information on colonoscopy screenings. Hope this helps.

Debra Posted Thu 25th of September, 2014 14:09:53 PM

Thank you!

One more quick follow up question to this.

This is for billing the E/M which is post-op to the colonoscopy.
Patient had polyps.

I want to code V58.49 (other specified aftercare following surgery)
and V12.72 (personal history of polyps). Would this be correct to code the post-op diagnosis for the E/M in this manner?

Thank you for your assistance.

SuperCoder Answered Fri 26th of September, 2014 07:47:40 AM

You are welcome. For this post op visit, is your provider actually performing an exam and history following the colonoscopy? It was my understanding that the patient was returning to the office for the pathology results days after the colonoscopy and not a visit on the same day. Normally a discussion of what the provider found is included in the work for the procedure unless the provider needed to see the patient for some reason that is beyond the normal pre and post-operative work.

Debra Posted Fri 26th of September, 2014 10:09:46 AM

In the MLN Global Surgery Fact Sheet I have it states that "for zero day post-operative period procedures, post-operative visits beyond the day of the procedure are not included in the payment amount for the surgery. Post-operative visits are separately billable and payable."

45385 has zero global days so I was under the impression that I can bill for the post-op days? Am I wrong in this...

SuperCoder Answered Mon 29th of September, 2014 07:56:16 AM

You are reading the article correctly. If your provider is having the patient come back for a follow up on a different day than the colonoscopy, then you will have no problem billing an E/M visit. The MLN states "post-operative visits BEYOND the day of the procedure are not included in the payment amount for the surgery". If your provider is seeing the patient following the colonoscopy on the same day, you should not bill an E/M unless your provider is providing a service that will be able to stand on its own. The E/M visit should be able to stand on its own separate from the procedure through documentation using time based billing or through the 3 components required for an E/M visit.

Debra Posted Mon 29th of September, 2014 13:48:44 PM

Yes it is a separate day, not on the same day as the procedure.

And thank you!

SuperCoder Answered Mon 29th of September, 2014 19:26:49 PM

Thanks for clarifying. You are very welcome!

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