Wiki ICD-9 for GI Consult

Create Wiki
E

erthsvr

Networker
Messages
28
Location
Yorktown, VA
Best answers
0
Good Morning All :)

I feel like this should be such an easy answer, but am confusing myself by probably reading too much into this.

I have a Medicare patient whose claim was denied for Routine exam/screening. This patient was referred to one of our GI specialists for a screening colonoscopy. Note states she had a negtive screening colonoscopy 10 years ago with negative findings. She does have severe deforming rheumatoid arthritis and mild chronic diarrhea. Explanation of colonoscopy procedure was done and advised patient on her medication use prior to the day of the procedure.

With this encounter, the office coded (1) V76.51 - screening for malignant neoplasms, colon and (2) 787.91 - diarrhea

CPT 99204 - Office/Outpatient Visit, NEW (this was pateint's first visit to the GI practice)

My question is, should the screening really have been diagnosed as such since he didn't perform the colonoscopy on this DOS?

Thanks :)

Heather MacPherson, LPN, CPC, CPC-H
 
Medicare has a transmittal, more than one i think, that states you may not charge for an E&M prior to a planned colonoscopy. She was referred for a screening colonoscopy, means this was a planned screening. The patient had already been evaluated and the determination for the screening already done, and it does not matter that she is a new patient, you still cannot charge for the E&M.
 
Transmittal Number (s)??

Thanks Debra......Do you know what transmittal number (s) I can find that info at on the CMS website?? I'm sure I will be asked to show proof.
 
I do not have the number but I know it has been provided in the forum before also you can do a search on the CMS website and you should be able to find it.
 
erthsvr said:
Thanks Debra......Do you know what transmittal number (s) I can find that info at on the CMS website?? I'm sure I will be asked to show proof.
Click to expand...

A provider preparing to perform a screening colonoscopy cannot also bill for a pre-procedure visit to determine the suitability of the patient for the colonoscopy. These E/M services, to include consultations, are not separately payable. While the law specifically provides for a screening colonoscopy, it does not also specifically provide for a separate screening visit prior to the procedure. Although no separate payment can be made for these visits currently, the fee schedule payment for all procedures, including colonoscopy, contains payment for the usual pre-procedure work associated with it. This reflects the principle that each procedure has an evaluative component.

http://www.cms.hhs.gov/mcd/viewlcd.asp?lcd_id=5774&lcd_version=28&show=all
 
You must log in or register to reply here.
Top