# Office Visit Prior to Screening Colon



## lisner1204 (Mar 18, 2013)

Hi, everyone.  I have docs that want to charge a new patient visit for a patient who is seeing them for an asymptomatic screening colonoscopy (patient over 50) when the patient has a commercial insurance.  For Medicare patients, we do not charge an office visit prior.  My physicians argue that they have to get the medical history and see the patient prior to the procedure for better medicine.  Any thoughts?  After reviewing several reports, there are larger payers that will pay the office visit.  Are we in danger in case of an audit?  Commercial payers USUALLY follow Medicare guidelines, but not always.  Any thoughts?  Thanks.


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## jmcpolin (Mar 18, 2013)

http://www.gastro.org/practice/coding/coding-faqs-screening-colonoscopy#s1 

This is from the American Gastrointestinal Association.


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## kathy a (Mar 19, 2013)

*Billing OV's for Colonoscopy's*

When a patient is coming in for a surveillance colonoscopy, has been asymtomatic but had a history of diverticulosis or colon polyps in the past, can you bill them for the office visit?
I think the answer would be No-due to- What is the chief complaint?, and What is the medical decision making? They know that they are coming in to be re-scoped. Now if they were coming in with signs and symptoms I could see billing for the office visit. Am I correct on this? The company that I work for feels that the office visits should be billed unless the patient is strictly asymtomatic and over 50, and would like to have a screening. Can someone please clarify this a little bit better to me so I can let them know. Thanks.


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## mitchellde (Mar 19, 2013)

If the patient is scheduled for a screening then the medical necessity for the test has already been determined and you cannot charge again for an assessment prior to the procedure.  Honestly anytime a procedure is scheduled prior to the patient comming in then you have no reason for an office visit due to the reason for the test and the medical necessity for this has already been determined.


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## kathy a (Mar 19, 2013)

Thank-you.


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## kathy a (Mar 19, 2013)

Hi Mitchellde..me again. So you are saying that the only time we can bill for the office visit prior to a Colonoscopy is strictly if it is for diagnostic purposes. That the patient is presenting with a problem?


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## mitchellde (Mar 19, 2013)

Yes that is the only time it is appropriate.


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## JoannaRupert (May 2, 2013)

*OV prior to Screening Colonoscopy*

I guess I am confused about this as well.  We see patients that are being referred to our office from other practices.  We do not know their medical history except for the office notes that are being sent to us.  We use both a hospital based facility as well an ambulatory surgery center.  We need to see and assess the risk to the patient prior to the procedure to know where to do the procedure as well as obtain a current medical history.  I would like to know if anyone can show me in writing where it states you cannot bill for a pre-op visit for a screening colonoscopy for a Medicare patient.  Thanks.


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## mitchellde (May 2, 2013)

this is one link among hundreds
http://www.gastro.org/practice/coding/coding-faqs-screening-colonoscopy
the first question asked is the one you have posed scroll down to the see the answer
How do I bill for a patient seen in our office prior to a screening colonoscopy with no GI symptoms and who is otherwise healthy?
A visit prior to a screening colonoscopy for a healthy patient is not billable.


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## fjohre (May 10, 2013)

*Ov prior to colonoscopy*

I disagree.  I believe you can charge for a Pre-Op Visit.  E&M code with DX code V72.83 for Pre-op visit & V76.51 Screeing for Colon CA.  A surgeon will not take a patient to surgery or perform a procedure unless He/She decides they need to and they are Physically able to be sedated.  Therefore I bill for it.


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## coachlang3 (May 13, 2013)

You might disagree but Medicare has stated the pre-procedure OV is not separately billable.  You can still have the visit but the payment for the visit is bundled into the procedure payment.

Private payors might feel differently but I haven't seen many who do.  Might depend on your contract with them.


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## lisner1204 (May 15, 2013)

*Thanks*

Thanks for all the thoughts and interpretations on this thread.  I have found out through the AGA website that if a Medicare patient has a condition that needs to be followed carefully due to risk (i.e. Coumadin Therapy) and it is documented and justifiable, an office visit can be charged. 

We are using the same guidelines for a patient with Commercial insurance (private payer) as screenings.  Remember the guideline is for primarily Medicare and not private payers.  I am finding that is depends on the patient's policy, as well.  

Just one of those things in our coding life that is clear as mud!  

Thanks again for the input.


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## lisaevans (Jun 6, 2013)

I have found that it is always paid/applied to the deductible.  I have never seen it denied.


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