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Leslie Posted Wed 18th of April, 2012 20:52:48 PM

An Internist does an E/M 99214,
List of Dx: 401.1, V45.89, V76.51(colon cancer screening)
He refers the patient out to a GI.
1)Can he still code V76.51(colon cx screening even though he is not providing the service.)
I think he can because he is taking care of it by referring to a specialist to do a colonoscopy.
2)Does the GI use G0105 (procedure), V76.51
If he provides a colorectal cancer screening? will this procedure code apply to all payers or just Medicare?


SuperCoder Answered Wed 18th of April, 2012 21:58:54 PM

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.

It is also important to understand that a referral for a screening colonoscopy does not constitute a consultation. A consultation is a distinguished from an office visit because it is provided by a physician whose opinion or advise regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source. If the primary physician is referring their patient for a screening colonoscopy, the need for a screening colonoscopy was already established and there is no opinion being sought.
When a patient is referred for a screening colonoscopy, the term “screening” indicates that the patient does not have signs or symptoms that support a diagnostic colonoscopy. Although the GI physician may wish to see and evaluate the patient prior to a screening colonoscopy, the evaluation and management visit is generally not separately billable.

This is from CMS:
Evaluation and Management Visit prior to Screening Colonoscopy
Q. Can a provider bill an E&M visit if a beneficiary is referred for a screening colonoscopy?
A. A provider preparing to perform a screening colonoscopy cannot also bill for a pre-procedure visit to determine the suitability of the patient for the colonoscopy. There E/M services, to include consultations, are not separately payable. While the law specifically provides for a screening colonoscopy, it does not also specifically provide a separate screening visit prior to the procedure. Although no separate payment can be made for these visits currently, the fee schedule payment for all procedures, including colonoscopy, contains payment for the usual pre-procedure work associated with it. This reflects the principle that each procedure has an evaluative component.

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