Gastroenterology Coding Alert

Question: When can a gastroenterologist bill for a preoperative consultation prior to a procedure that he is going to perform?

Wyoming Subscriber

Answer: GI coders commonly face this conundrum, primarily for Medicare patients whose primary-care physicians send them to the GI for a screening colonoscopy examination (G0105, G0121). Medicare has bundled routine preprocedure visits whose sole purpose is to discuss the screening colonoscopy preparation in an otherwise healthy patient.
 
While you cannot bill a consultation code for these services, your carrier may accept billing for an E/M service if the gastroenterologist evaluates a patient with co-morbid disease prior to the colonoscopy. This visit may be necessary to adjust the patient's medicine (for example, for insulin-dependent diabetics) or because the patient may not be an appropriate patient for an ambulatory endoscopy center (severe COPD). In these cases, the ICD-9 diagnosis code should be related to the co-morbid disease.