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colonoscopy pre consults

Wanett Posted Tue 28th of December, 2010 17:51:00 PM

Regarding medicare guidelines, if a pt is over 70 they must be seen by the dr before having their colonoscopy. The pt is 72 and no prior hx of polyps,etc so the 99213 ov done a few days prior to the proc & 45378 (G0121) were coded w/dx V76.51 & that's it. Medicare is denying the 99213 stating routine non cvrd & the eob states we can bill the pt for the visit. However i'm thinking if mdc requires the pt to be seen due to age before procedure then they should cover it. Are we coding the ov wrong??? Any help is greatly appreciated.

SuperCoder Answered Tue 28th of December, 2010 21:49:56 PM

A provider preparing to perform a screening colonoscopy cannot bill for a pre-procedure visit to determine the suitability of the patient for the colonoscopy. There E/M services, to include consultations, are not separately payable. While the law specifically provides for a screening colonoscopy, it does not also specifically provide a separate screening visit prior to the procedure. Although no separate payment can be made for these visits currently, the fee schedule payment for all procedures, including colonoscopy, contains payment for the usual pre-procedure work associated with it. This reflects the principle that each procedure has an evaluative component.

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