Gastroenterology Coding Alert

Learn multiple ways to report an asymptomatic screening, and you'll be ready no matter what the carrier wants

Gastroenterology offices that don't know how to properly report asymptomatic precolonoscopy screenings as both a preventive service and an evaluation and management service are at risk of filing ineffective claims and opening their offices up to payer suspicion.
 
Before scheduling a screening colonoscopy (G0105, G0121), a gastroenterologist evaluates a patient to make sure he has no conditions that would put him at risk during the procedure. If the patient has a risk factor that the gastroenterologist feels needs further exploration, he schedules an E/M service appointment before the colonoscopy.

Red flag: But what happens when the doctor performs the prescreening and the patient has no comorbidities? Should you report a preventive service or an E/M code?

There are two schools of thought on which code series to choose from when reporting asymptomatic precolonoscopy screenings: Some swear by preventive service codes, while others prefer to report an E/M service.

"This is a hot topic right now," says Linda Parks, MA, CPC, CMC, CCP, coding specialist at GI Diagnostics Endoscopy Center in Marietta, Ga. Parks says she has debated the issue with other experts at coding conferences and on gastroenterology-specific e-mail lists.

Unfortunately, professional debate has not led to a consensus on what the proper code is for reporting an asymptomatic patient's precolonoscopy screening.

Best bet: Contact each individual insurer before filing a claim to see what its policy is on coding asymptomatic precolonoscopy screenings. The insurer will likely tell you to file it as either a preventive service or an E/M service.

Here is a quick look at each reporting method, as well as some ways gastroenterology offices are avoiding the problem entirely -- while simultaneously making things easier on their doctors, nurses and fellow coders. Method 1: Report a Preventive Service Rochelle Cox, practice administrator at the Carolina Center for Liver Disease in Charlotte, reports preventive service codes for asymptomatic colonoscopy screenings.

"Depending on the patient's age, we code either 99386 (Initial comprehensive preventive medicine evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization[s], laboratory/diagnostic procedures, new patient; 40-64 years) or 99387 (... 65 years and over) for asymptomatic screenings," Cox says.

Explanation: The logic behind reporting the preventive codes is sound. Cox points out that CPT has no frequency-period guidelines for reporting preventive services, and there is no rule stating that only primary-care physicians can provide preventive services.

"As long as you perform a history and exam, which we do, you can report a preventive service," Cox says. Method 2: Report a New Patient E/M Visit However, other coding experts [...]