Wiki Colon Cancer Screening

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missyah20

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Good Morning,
We have been receiving denials for patient's pre-op E/M charge for colon screening. These patient's are seen about 3 days before their colonoscopy. The reason for the visit is Colon Cancer Screening. We are billing this E/M visit with a dx code of V76.51. Medicare is denying as routine and stating this is pt resp. Is that correct? Is there anyway we can get this pd? Thanks for the help!
 
Are you the provider who is doing the actual colonoscopy? Pre-op exams prior to a screening test is inclusive of the gobal surgical package.

basically your E/M code with that screening diagnosis is saying there are no symptoms, and therefore would not be covered by Medicare
 
Yes we are the provider who is performing the colonoscopy. Do you know where I can find documentation of this on Medicare's website?
 
Medicare's PRIT (Physician Regulatory Issue Team) posed this question in 2002 and the answer was a round about response to your question:

Q: "The American College of Gastroenterology has asked the PRIT if there are circumstances under which Medicare might pay for a preprocedure visit for a patient scheduled for a screening colonoscopy."

A: "Dec 17, 2002:Medicare coverage is permitted for services which are "reasonable and necessary for the diagnosis or treatment of illness or injury" by law (Title 18 of the Social Security Act 1862(a)(1)(A)) and therefore a precolonoscopy E&M which meets this requirement will normally be covered. An E&M visit which does not meet this reasonable and necessary standard is defined as noncovered by the law. Only congress can allow exceptions to this reasonable and necessary standard by creating a special benefit category as it has for each of the preventative benefits now covered by Medicare."

See http://www.cms.gov/PRIT/PRITIP/item...r=ascending&itemID=CMS062967&intNumPerPage=10
 
Thanks! I am having a hard time convincing my employer that Medicare is not going to pay for an E&M when the screening(V7651) code is primary. Would it be inappropriate to use code V72.83 as the primary diagnosis instead of V7651 when the patient is seen for a pre-op visit prior to colonoscopy?
 
You can get these paid by filing the E/M visit with the "G" code for colorectal cancer screening.

G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk) for an average-risk Medicare screening colonoscopy

G0105 (Colorectal cancer screening; colonoscopy on individual at high risk)
 
G0121 and G0105 are not e/m's. They are equal to filing a 45378 which is a colonoscopy. I do not advise filing those for your pre-op visit e/m.
 
Your Doc can't see the patient and order a screening scope and then do a pre-op on his own patient to see if the patient (that he just saw) has any contraindications for doing the screening scope he just ordered. It would be real hard to argue medical necessity

He can see the patient and code an E&M if the patient comes in with a problem. Such as "I know you wanted to do this scope day after tomorrow but I have been throwing up for 2 days".

Hopefully the physician is not using this pre-op visit to just tell the patient how to prep and sign consents. That's all inclusive to the procedure

I would not use V72.83. Scopes are diagnositic procedures with a same day global. They are not surgeries with a 90 day global
 
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