Gastroenterology Coding Alert

Question: We get denials when we bill 99203 or 99204 with diagnosis code V76.51. The insurance says we can't bill a screening with these CPTs because they are medical. What is your advice?

Colorado Subscriber

Answer: If it's a pre-colonoscopy visit, Medicare and some commercial carrier consider the service as included in the colonoscopy procedure and not medically necessary as a separately billable service. For the insurance carrier that does cover this service, you should bill as a pre-procedure visit and report V72.83 (Other specified preoperative examination) as the diagnosis.

Tip: Report the service for what it is. You are not screening for colon cancer at the pre-procedure visit itself, which is not done until the patient actually has the colonoscopy.

Warning: Be careful with Medicare. If there aren't other things going on with the patient, then a routine pre-colonoscopy visit is not a billable service. If the patient is asymptomatic and has no medical issues managed by the gastroenterologist, then the service would not be considered medically necessary by Medicare and some other payers. However, if the patient is symptomatic or has a medical condition that must be managed during this visit in preparation for the colonoscopy procedure, then it should be covered, according to these Medicare Guidelines.