Gastroenterology Coding Alert

A simple checklist may be the answer to all your problems
 
If you-re uncertain whether you should count an asymptomatic precolonoscopy screening as a reportable E/M service, you-re not alone. Check out this expert advice and see where you stand.

Scenario: Before scheduling a screening colonoscopy (G0105, G0121), your 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 thinks needs further exploration, he might schedule an additional E/M service appointment before the colonoscopy.
 
Should your report an E/M service or count this visit as part of the colonoscopy? Evaluate E/M Visit Option Some coding experts contend that you can count a precolonoscopy screening as an E/M service.
 
You would report 99201 (Office or other outpatient visit for the evaluation and management of a new patient ...) with diagnosis codes V72.83 (Other specified preoperative examination) and V76.51 (Special screening for malignant neoplasms; colon) attached to strengthen the claim. These codes prove the gastroenterologist performed the E/M service to ensure a new patient's safety before a colonoscopy.

Reasoning: -If you do decide to submit a claim for a patient with no symptoms, you have to code it as a new patient or established patient visit,- says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.

Good idea: Have the patient sign an advance beneficiary notice (ABN) so you can collect this amount from the patient if his commercial insurance carrier won't cover a visit with no symptoms, says Connie Pitman, a coder in Lubbock, Texas.
 
But that's not usually the norm, Pitman says: -We-ve found that a Medicare patient often has some symptom that will make this a payable visit, such as a change in bowel habits or constipation. Just make sure you-ve got documentation for it.-

Include It as Part of the Colonoscopy On the other hand, you know that CMS considers a routine preoperative E/M visit (V72.83) prior to a screening colonoscopy (G0121) as included in the screening service. For that reason, you can consider this pre-op visit as a nonreportable visit.

-In my opinion, if you schedule the patient for a screening colonoscopy, there should be no charge for the prescreening visit,- Parks says. -The only time you would charge for a prescreening visit would be when the patient has other symptoms that would make this service diagnostic rather than screening.-

Just because you consider this visit a no-charge, however, you still have alternatives to a full-fledged E/M service code. Alternative 1: Formulate a Checklist Did you know? You can formulate a precolonoscopy screening checklist. The checklist should contain all factors that may put a patient at risk during a colonoscopy. Once you [...]