Gastroenterology Coding Alert

Question: Which ICD-9 code should be used to report a consultation performed prior to a screening colonoscopy? We are doing a specialty-specific comprehensive history and physical prior to the procedure, always on a separate date. We complete a comprehensive history and specialty-specific physical exam along with detailed informed consent discussion. Our nurses then typically spend an additional 10-15 minutes discussing prep, risks, obtaining consent signature, etc. Usually we can elicit at least some gastrointestinal problem during the interview or exam, but occasionally there is absolutely nothing.

Nevada Subscriber

Answer: If the patient has no gastrointestinal signs or symptoms, you should use diagnosis code V76.51 (special screening for malignant neoplasms, colon). Don't expect to get reimbursed for the consultation, however, even though it appears you are doing a thorough workup of the patient. 

In general, Medicare does not pay for preventive services. Neither do most commercial insurers. Medicare's coverage of screening colonoscopies and flexible sigmoid-oscopies is the exception to that rule, but it will not cover the office visit that most gastroenterologists require before they perform the screening procedure. 

Many gastroenterologists have the patient sign a waiver acknowledging financial responsibility for the consultation. When the patient calls to set up the office visit, he or she is informed that consultation is not a covered service, and that he or she must pay for it.