Wiki Colonoscopy consult

[coding4fun]

Scenerio:
pt is seen by a Family Physician doc to discuss medical issues relating to HTN, DM2 & HTN and during this visit states "I would like to have a colonoscopy". This pt is referred to a PA to have a "colonoscopy consult".

I realize that when the pt sees his FP doc he is billed the appropriate OV level with the appropriate dx for the HTN, DM2 & HTN. Can you actually bill the pt for his visit to see the PA for colonoscopy consult. Is so what would you be billing with what dx? I was not aware that Medicare or any other carrier would allow you to charge for a OV Level 2 with the colonoscopy coding.

Thanks for any insight you guys can share with me.

 

[lorrieb23]

Prior to my arrival at my current practice, we billed for the colonoscopy consult with a screening v code. Insurance always denied and it was passed to the patient. I think these visits should be billed as pre op with an E&M code. But I too cannot seem to get any feedback. The only thing I have been told here at my practice is that most insurances will consider this visit prior to the colonoscopy as included with the procedure. But it's difficult to convey to a physician that they will be seeing the patient and 'not getting paid'. Anyone with any experience with this situation?

 

[pamsbill]

Medicare considers a visit prior to a screening colonoscopy to be included in the payment for the colonoscopy. You cannot bill it for Medicare patients.

Many practices now offer "direct access" where you register as a patient, are prescribed the prep and you go get your colonoscopy. This is a result of not being allowed to bill the visit prior to a screening. I'm sure you can google direct access screening colonoscopy and see what other practices are doing.

Some commercial insurance policies will allow a visit prior to a screening, but it varies from insurance to insurance and from policy to policy. I have always wondered how an office visit would pass an audit if the patient had no symptoms. If there is no context, severity, location, timing, etc. - all the things an auditor starts counting to verify an E&M level - then it would never justify an E&M code anyway.