Wiki E/M with colonoscopies

[svms]

I am of the understanding that you do not bill E/M's prior to a colonoscopy if they are screening.

Can someone direct me to a link that states I CAN bill the E/M's that are diagnostic.

I am new to billing General Surgery/Gastroenterology. We are a small multi-specialty and have just brought this surgeon on board. So not only am I new to billing for him, but I also want information I can use for provider education.

 

[sherryo35]

http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8EELDY5430


Jurisdiction 11 Part B
Screening Colonoscopy and Evaluation & Management Service on the Same Day
Typically, patients referred for a screening colonoscopy do not have signs or symptoms that support a diagnostic colonoscopy. The physician performing the colonoscopy may wish to see and evaluate the patient prior to the screening colonoscopy. In this case, the evaluation and management (E/M) visit is generally not separately billable.

Even though some patients may be at high risk for the procedure due to concurrent conditions that may affect the decision to perform the procedure, the patient evaluation for these risk factors is included in the usual pre-service work associated with the screening colonoscopy.

A separate E/M service may be submitted for patients that are referred for a screening colonoscopy when either of the following scenarios occurs either when:
?All the required components of the E/M are documented and based on this evaluation the physician decides not to proceed with the procedure
?All the required components of the E/M are documented and the physician determines the patient has signs and symptoms that warrant a diagnostic colonoscopy instead of the screening colonoscopy
It is also important to remember that when a screening colonoscopy detects a lesion or growth resulting in a biopsy or removal of the growth, the appropriate diagnostic colonoscopy with biopsy or removal code must be submitted rather than the screening colonoscopy code.

 

[tcade]

Tina Cade CPC, CGIC

I am of the understanding that you do not bill E/M's prior to a colonoscopy if they are screening.

Can someone direct me to a link that states I CAN bill the E/M's that are diagnostic.

I am new to billing General Surgery/Gastroenterology. We are a small multi-specialty and have just brought this surgeon on board. So not only am I new to billing for him, but I also want information I can use for provider education.

You cannot beill an E/M code with a colonoscopy as it will be denied.

 

[agibb1022]

I am of the understanding that you do not bill E/M's prior to a colonoscopy if they are screening.

Can someone direct me to a link that states I CAN bill the E/M's that are diagnostic.

I am new to billing General Surgery/Gastroenterology. We are a small multi-specialty and have just brought this surgeon on board. So not only am I new to billing for him, but I also want information I can use for provider education.

We do not routinely bill E/M visits for screening colons because they aren't typically covered. However, if there is a medical condition that is not GI related but can affect the procedure (for example: the patient is on Warfarin) then we complete one a few days prior and they are covered. This gives the dr the opportunity to determine if the procedure can be done at the ASC under conscious sedation or if they need propofol, or if they need to be done at an outpatient hospital because there is a greater risk of complications that can't be addressed at the ASC. In those situations, we bill an E/M with Z01.818 Encounter for preprocedural examination, along with the ICD10 code for the medical condition.