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  1. JH Posted 2 month(s) agoRelated Topics

    Patient is New. Patient is being referred for a screening colonoscopy. Patient has no complaints, Patient has a family history of colon cancer. Comp exam and extended ROS. Physician billing for a 99204. Z00.00; Z80.0; Z12.11 *Colonoscopy being performed on another day. Patient has private insurance; Blue Cross. Would this claim be payable with these codes? Is this a billable situation? or is there a billable situation here?

  2. SuperCoder Posted 2 month(s) ago

    CMS does not pay for an Evaluation and Management service prior to a screening colonoscopy.  If a patient is referred from another physician to schedule a screening colonoscopy, do not bill any type of E/M service prior to the procedure.  

    • A visit prior to a screening colonoscopy for a healthy patient is not billable.  

    • Report only for the colonoscopy procedure, on the day it was performed.

    Do check with your payer, for separate reimbursement guidelines for evaluation and management prior to screening colonoscopy.

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  • Posted by 130261 JH, 2 month(s) ago. There are 2 posts. The latest reply is from SuperCoder.