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E/M for screening colonoscopy

Sharon. Posted Thu 16th of August, 2012 13:54:57 PM

I have a new GI doc and he wants to see the patients(who are coming in for a screening colonscopy) before he does the procedure which can be scheduled down the line. Can I charge for this visit? He says yes but I am very uneasy about doing this. Your help is very much appreciated. I have been putting off his charges until I can get an answer. Thanks

SuperCoder Answered Thu 16th of August, 2012 14:51:34 PM

CMS does not pay for an Evaluation and Management 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.

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