Wiki Many ?? re: colonoscopy

[trinalankford]

I know this has been beat to death, but there are still questions.

My doc performs several colonoscopies per week (he is a general surgeon). The majority of these are straight screening, i.e., referred from another office for screening. These patients come into the office before the procedure (sometimes several weeks to months) to discuss the procedure with our nurse, get instructions for prep, etc., and this is a "no charge" visit.

HOWEVER, if the patient discloses during this interview with our nurse that he/she has had SYMPTOMS and not just requesting screening, does this still constitute screening? I'm under the impression that the minute the patient made mention of symptoms, "screening" is no longer accurate.

I'm also under the impression that any patient referred for STRAIGHT SCREENING COLONOSCOPY (no symptoms, no family history, no personal history of polyps) cannot be charged for an E/M visit with the physician. If the screening patient has a personal history of polyps, can he/she be charged for an E/M with physician?

In addition, any patients referred for colonoscopy to our office who actually have symptoms, i.e.., rectal bleeding, anemia, etc., we are scheduling them with the surgeon for the "preop" visit, to verify that is what he wants to do, and charging an E/M visit code with symptoms as diagnosis code. The colonoscopy is then scheduled at this visit. Is this not correct? Should we actually NOT be charging them an E/M?

Bottom line....Can we EVER charge an E/M before a colonoscopy? Screening colonoscopy? Diagnostic colonoscopy? There is so much information out there regarding this, but a lot of it is definitely contradictory. Because this is a bulk of our everyday business, we need to get this clarified ASAP.

I have read every post on this forum about this, and I do appreciate everyone's help.

Thank you.

Trina

 

[acbarnes]

OH Trina, I feel your pain.

Scenario 1:
If patient comes in with no symptoms and they just need to have a screening for either preventive age 50+ once every 10 years or high risk (i.e. personal hx, family hx, etc), then you cannot bill an E/M. There is nothing to evaluate and manage. In most cases the patients are being sent by a PCP to have the procedure. The PCP already determined they needed it. All your MD is doing is going over their H&P, discussing risks & benfits, and scheduling. This is pre-op work. AGA has very good articles on this.

Scenario 2:
If patient comes in with sign and symptoms, your MD has to perform an evaluation and managent visit to determine the plan of care which includes the treatment and/or diagnostic studies (i.e. colonoscopy).

Then we see patients that write "routine screening" on their intake form, get back to the physician (in your case nurse) and want to talk about the bleeding, diarrhea, and constipation they have been having. This requires a "time out." Someone needs to say to the patient, "I see you stated you were not having symptoms; however, I am happy to discuss your current signs/symptoms, but this will involve an office visit." If a visit takes place and the physician evaluates and manages signs/symptoms, he/she bills appropriately.

In our practice at check in we give the patient a screening disclaimer which says that a discussion of signs and symptoms may result in an office visit and may not be considered preventive. Then they go to the scheduler. If the physician hands her a symptom diagnosis instead of screening, she hands the patient a piece of paper that states the patient is now aware the are undergoing a colonoscopy for xyz symptoms, not a screening.

I hope this helps.

Anna Barnes, CPC, CEMC, CGSCS

 

[trinalankford]

Huge help, thank you. I'm printing this out and having our receptionist/scheduler review.

 

[DUEEAST]

Military Treatment Facility

In regards to the E&M for colo screening, coding is a bit different due to our facility being non- medicare, military hospital.

The issue we are having with our general surgeons is the level of risk they want to put on a colo evaluation. If pt has a secondary condition of hyperlipedemia, obesity, "50 years old", the surgeons feel quite confident in coding these brief evaluations as level 4 and 5, new patient/estbl. paitent. The HPI is "soaked up" as is the physical exam. I ask, " do you really do a breast exam on a colo screen eval?" They reply that yes they do.

Guidence would be most appreciated!