Wiki EM Screening code 99386

[bsullivan]

I am new to Gastroenterology and need help with the Preventive Medicine Service codes. I have received mixed information about New patient office visits for pre-evaluation to Colonscopy screening. Can we use 99386, (defined by age) as the E/M visit with the appropriate Vcode for the diagnosis? I have been told that in our community only PCPs can use this code for preventive visits, and we shouldn't as the specialist. I am aware that Medicare does not pay for this visit, but am looking for information about commercial insurances. Thanks for your help.

 

[jsanders820@att.net]

When patient's are sent to a specialist its not for "preventive care" it for further diagnosis of a condition detected by the primary care physician. Therefore these codes cannot be used by a specialist. You can use a Higher E/M code as long as documented correctly with the V code for screening.

J Sanders @ AA's Medical Coding and Billing Services, LLC

 

[pamsbill]

I am new to Gastroenterology and need help with the Preventive Medicine Service codes. I have received mixed information about New patient office visits for pre-evaluation to Colonscopy screening. Can we use 99386, (defined by age) as the E/M visit with the appropriate Vcode for the diagnosis? I have been told that in our community only PCPs can use this code for preventive visits, and we shouldn't as the specialist. I am aware that Medicare does not pay for this visit, but am looking for information about commercial insurances. Thanks for your help.

This goes on in some offices with which we deal too. The docs think they can use a preventative code to get a pre-screening visit paid. The problem is, those 9938X codes are really for full physicals and not meet-and-greet pre-screening visits.

You can go to the AGA website (www.gastro.org) and look for FAQs for coding screening colonoscopies and you will find where it states:

"A visit prior to a screening colonoscopy for a healthy patient is not billable."