Wiki E/M with procedure Inpatient

[pscar]

I work in a Gastroenterology office and we have PA's and FNP who see pts as a subsequent visit and then MD will do procedure same day. Can I bill the visit with -25 or just bill the procedure( colonoscopy, EGD etc.) We have been back and forth with this. Any clarification or resources on where to find a "simple" answer I can give my providers would be GREATLY appreciated.

 

[vpat28]

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.

?CMS Internet Only Manual ' Preventive Services Manual (PDF, 1.47 MB) 100-04, Chapter 18, Section 60