Wiki Billing Preventive Medicine Codes

[jackierosario821@yahoo.com]

I work for a GI group and we have recently run into an issue with UHC and the pre-colonoscopy visit. These are being billed with the appropriate level E/M code and dx code V76.51-special screening malignant neoplasm colon. We are being told by UHC (this is the only payer processing these claims this way) that this code combination is not considered preventive. We have always billed this way and they are usually covered under pt's preventive portion of plan. Can we bill Preventive Medicine codes99381-99397? If we can what is the doctor required to do and document during these visits? Has anyone else run into this recently?

 

[mitchellde]

You should not use the V76.51 code for an office visit. This is not the encounter for the screening. If you bill this with a preventive E&M or with an office visit it communicates that you have performed a screening procedure and you did not. In the ICD-10 CM guidelines it states to use the screening Z codes only when the screening procedure is being performed. I know we are still using ICD-9 but the logics and application is all the same. The ICD-9 guidelines were not updated with this as they stopped updating ICD-9 after October 2011.
The problem is you really have no dx code that is applicable for the pre screening procedure encounter. Which is why Medicare does not allow it to be charged.