JH Posted Sat 02nd of December, 2017 04:52:12 AM
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?
SuperCoder Answered Mon 04th of December, 2017 03:31:10 AM
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.