Gastroenterology Coding Alert

Question: We generally perform open access endoscopy (no visit is required if the patient was referred specifically for endoscopy). Sometimes, however, the patient would have a condition that warrants a pre-procedure office visit. What are the diagnosis codes to use in this scenario, and how should we sequence them?Colorado SubscriberAnswer: Generally for pre-op clearance, ICD-9-CM instructs to list first the reason for the visit (in this case, 'pre-surgery clearance'), a V-code (i.e., V72.83, Other specified pre-operative examination, or V72.84, Pre-operative examination unspecified). Next, sequence the condition describing the reason for the procedure as an additional diagnosis. Also, don't forget to code any finding related to the evaluation. You cannot bill an E/M code for any type of preprocedure office visit on the same day as a scheduled procedure.Some cases, however, should be handled depending on payer's policies. It's always safe to check with the payer first about their code sequencing [...]