Wiki E/M dx for screening colonoscopy

[sluke9]

Scenerio: patient present to the office to schedule a screening colonscopy. The E/M was done 45 days before the actual scope was done. I have always used V76.51 to indicate that a screening colonoscopy is planned. The patient has no history or problems and this is just a routine over 50 screening. Medical Mutual is denying the E/M stating that it must be billed as a preventative visit CPT.

If you don't use V76.51, what would indicate the 'need' for colonscopy. I don't agree that a preventative visit code is appropriate by a specialist. Any ideas??
Thanks,

 

[blathrop19@gmail.com]

My doctors don't do E/M's for screenings and I think you are not supposed to bill for that. I could be wrong, but I think that is what has been said in earlier posts in this forum.

Bob

 

[coachlang3]

Medicare bundles the OV prior to the actual screening into payment of the procedure. Most other payors do as well.

 

[cansas]

agree. The visit prior to the screening is typically considered part of the procedure, regardless of how many days prior to the colonoscopy it is.