Wiki Colonoscopy-billing ov prior to procedure

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kathy a

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I know that this topic has been addressed many times. I know that an office visit prior to a screening on an asymptomatic patient is non-billable. The billing company I work for is trying to tell me that it is billable. They say that those rules apply only to Medicare patients? The diagnosis the physician uses is for a screening. So where would the medical necessity/decision making be? He knows the patient is presenting for a screening. I know you can bill for the visit prior if the patient is on coumadin therapy. I am being told that I should be billing these pre-op visits out to other insurances because they pay. The physicians office is collecting co-pays on these visits, which is causing a back-log of payments that need refunded to the patients. Are we allowed to bill these E&M's to other insurances? I have always held our AAPC rules as sacred and do not want to be billing out things when I believe them to be wrong. Can someone please let me know the answer to my problem. If I am told I have to bill these out, is this fraud? Thanks :confused:
 
You have to keep in mind that Medicare has the rule that they do not pay for the E/M for a screening colonoscopy. This is only pertaining to Medicare.

If you are dealing with a patient for Blue Cross Blue shield - they may cover the office visit for a screening colonoscopy prior to the procedure, but, you have to do your due diligence and call and check benefits before you actually see the patient. You would want to use the Preventive Medicine E/M codes 99381-99387 for new patients and make sure these codes are a covered benefit by the patients insurance plan with the appropriate screening dx code.

Good luck!
 
So you are saying you can bill an office visit prior to a screening on a new patient then- using the preventative codes for their age? What about an established patient? Will this cause a problem for them down the line if they are seeing their PCP the same year for their yearly preventative exam?:confused:
 
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