Gastroenterology Coding Alert

Will you choose the right codes?

Test your colonoscopy and E/M coding expertise with this two-question quiz. Find out how you measure up.

Question 1: During a colonoscopy on a Medicare patient, the provider got a far as the splenic flexure but could not advance any further due to poor preparation despite numerous attempts at lavage and suctioning. The gastroenterologist thought that moving forward with the procedure was unwise for fear of perforation. The patient will undergo further prepping and re-examination at a later date. Which modifier should you report?
 
A. 50
B. 51
C. 52
D. 53

Answer 1: D. You should use modifier 53 (Discontinued procedure) because the gastroenterologist attempted the procedure and then stopped. That way, the patient can reschedule the procedure with no problem.

Generally, you would use modifier 50 (Bilateral procedure) with orthopedic procedures for right and left extremities, and this modifier would not be appropriate for a colonoscopy because the colon is not a bilateral organ.

You wouldn't use modifier 51 (Multiple procedures) because the gastroenterologist did not perform another procedure during the same session. And although modifier 52 (Reduced services) might seem like a reasonable choice, it is not accurate in this situation.

Question 2: A provider conducts a family counseling session without the patient present. The session lasts 25 minutes. Which code would you use to bill for the counseling session to the patient's carrier?

A. 99212
B. 99213
C. 99214
D. None of the above

Answer 2: D, None of the above. The patient would have to be present to bill his carrier for a follow-up E/M visit. Each established patient code listed (99212-99214) requires that the patient be present for the visit.

Frequently, you can bill this type of encounter directly to the family member who meets with your physician, and you can use the conference and counseling time factors of the E/M codes (99212-99214) if the family members- visit meets the coverage requirements outlined in the Medicare Coverage Issues Manual. According to the manual, Medicare will pay for a visit with a family member if the patient is withdrawn and uncommunicative due to a mental disorder or comatose and the physician needs information from family members to aid in the diagnosis or treatment of the patient. When a physician contacts his patient's relatives or associates for this purpose, according to the manual, you can properly charge for the expenses of such interviews as physician services to the patient on whose behalf the gastroenterologist secures the information.

The manual states that the physician must request information from the family to aid in the patient's treatment. The family member may not request advice or guidance from the physician as in the question above.

Medicare also covers counseling to family members under two circumstances:

1. When there is a need to observe the patient's interaction with family members, and/or when there is a need to assess the capability of and assist the family members in aiding in the patient's management.

2. When the counseling is directed at the treatment of the patient's condition. It is never covered when it is aimed at dealing with the problems of the family members, including the effect of the patient's illness on the family.

Answers were provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, an independent coding consultant in Marietta, Ga.