Gastroenterology Coding Alert

Question: One week after a preventive visit with his primary-care physician, a patient was referred to our office for a precolonoscopy screening. The gastroenterologist performed a history and physical before the screening (the actual colonoscopy is scheduled at a later date). Can the precolonoscopy visit be reported as a preventive visit?

Alaska Subscriber
 
Answer: In this case, yes. Code the screening visit 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision making) with the ICD-9 codes V72.83 (Other specified preoperative examination) and V76.51 (Special screening for malignant neoplasms; colon).
 
Don't report the visit as a consultation, because you are not reporting any codes other than preventive ones. Some carriers, including Medicare, will not pay for pre-screening colonoscopy visits on otherwise healthy patients. If the patient has a comorbid condition that requires modification of the colonoscopy preparation or adjustment of medications, the diagnosis code for that condition should be reflected in the preoperative examination code.
 
In addition to V72.83, these pre-op exam codes may also be used if a patient has a comorbid condition that creates these circumstances:

  V72.81 - Preoperative cardiovascular examination
  V72.82 - Preoperative respiratory examination
  V72.84 - Preoperative examination, unspecified
  V72.85 - Other specified examination
  V72.9 - Unspecified examination.