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Diagnostic E/M with colonoscopy

Debra Posted Mon 18th of August, 2014 16:17:36 PM

I am of the understanding that you do not bill E/M's if they are screening for a colonoscopy.

Can someone direct me to a link that states I CAN bill the E/M's that are diagnostic.

I am new to billing General Surgery/Gastroenterology. We are a small multi-specialty and have just brought this surgeon on board. So not only am I new to billing for him, but I also want information I can use for provider education.

SuperCoder Answered Mon 18th of August, 2014 21:16:42 PM

You are correct that you should not bill an Evaluation and Management code when a patient is being seen before a screening colonoscopy. CMS does not pay for an E/M service prior to a screening colonoscopy. If a patient calls or is sent from another physician to schedule a screening colonoscopy, do not bill any type of E/M service prior to the procedure. Some commercial carriers also follow this policy.

If the patient needs a diagnostic colonoscopy, for a symptom or disease, the physician may see the patient and report a medically necessary E/M service.

If it is not significant and separately identifiable from the evaluation/exam typically done prior to a colonoscopy, it should not report be separately. If it is significant and separately identifiable, then it can be coded as either a consultation or an office/outpatient visit. Whether it can coded as a consultation will depend on whether you have requested his advice or opinion regarding evaluation and/or management of a specific problem and whether he provides you, as the requesting physician, with a written report in return. Some payers do not recognize consultations between physician partners or physicians of the same specialty in the same group practice. If the E/M service is significant and separately reportable and otherwise does not meet the definition of a consultation, the office encounter should be coded using an office/outpatient visit code, such as 99213. In either case, modifier -25 should be appended to the E/M code to indicate that it was a significant, separately identifiable service from the colonoscopy done on the same date.
If the provider is briefly meeting the patient and following a brief question and answer period, the provider decides to complete a colonoscopy, you would not bill the visit separate. See the following links for additional information.

http://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/you-be-the-coder-45378-in-place-of-an-em-code-article

http://www.aafp.org/fpm/2005/0500/p27.html

http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8EELDY5430

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