Wiki help with a code!

[ksumner]

I work for 3 colorectal surgeons, who require an office visit before a screening colonoscopy. They usually use V76.51 as the diagnosis (patient is asymptomatic and is only coming in for a colonoscopy because their pcp says they need to...). Then, the doctors use the cpt code of 99201, 99202, 99203...So....the insurance companies apply this to the patient's deductible and the patients are not very happy about this. For a while, we were using 99386, but have since been told that that code really only applies to pcp's, not specialists. Do you think I can use 99402? Or, is there another code that would be appropriate? Even though I am a certified coder, I really only work as a biller, and I took the classes years ago, so any help would be greatly appreciated!

 

[Kisalyn]

This is from the American Gastroenterological Association:

How do I bill for a patient seen in our office prior to a screening colonoscopy with no GI symptoms and who is otherwise healthy?

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

If the patient wants to talk to our doctor before scheduling a screening colon, it's supposed to be a 'meet and greet.' The payment for the colonoscopy includes the usual pre-procedure work so unless there is something the patient needs to be evaluated for, a visit is not billable.

 

[vandell57]

I work in a GI office and this is what info I have. Medicare will not pay for a colon screening evaluation, however, other insurance will pay depending on the dx. If the pt is over 50 and has no other dx this can be covered under their wellness (if avail), if other dx then it is not wellness and will apply to their deductible. We have a lot of unhappy pts as well but they should be aware before they even have the procedures. Hope this helps some.