SuperCoder Posted Tue 14th of May, 2013 15:29:49 PM
PCP’s will send Medicare patient to our office for a “screening colonoscopy”. There are times the patient will have other issues as well. Ex: GERD or Esophagitis. Can the doctor bill for an office visit because the patient has presented will a problem? The doctor will be doing a colonoscopy and the EGD if appropriate. Thank you.
SuperCoder Answered Wed 15th of May, 2013 12:40:37 PM
Your doctor is providing two services. The first is the colonoscopy itself. According to CPT, colonoscopy, whether diagnostic or screening in nature, would typically be coded with 45378, “Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure).” Medicare, of course, has its own codes for screening colonoscopies: G0105 for individuals at high risk and G0121 for other Medicare beneficiaries. For screening colonoscopy, use an appropriate diagnosis code (e.g., V76.51, “Special screening for malignant neoplasms; intestine; colon”) to reflect the screening nature of the service. For diagnostic colonoscopy, use a diagnosis code that reflects the pertinent findings of the procedure or the symptoms that prompted it.
The other service you asked about is an evaluation and management (E/M) service. If it is not significant and separately identifiable from the evaluation/exam typically done prior to a colonoscopy, your doctor should not report it separately. If it is significant and separately identifiable, then he can code it as either a consultation or an office/outpatient visit. Whether he can code it 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. It may also depend on your business relationship with him. 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.
SuperCoder Posted Wed 15th of May, 2013 16:14:07 PM
Sorry may not have stated the problem the right way. Our DRS prefer to see patient's in our office before they schedule a screening colonoscopy,for a different day. The patient will come to the office the doctors will discuss the procedure and then the patient will go to our scheduler. We do not charge for this office visit. There are times, however, when the doctor (from ROS) or the patient will discuss issues other than the colonoscopy. These issure usually have to do with UGI. When issues with the UGI have been discussed can he bill for that office visit with the UGI DX code? Thanks