Wiki Office Visit BEFORE Colonoscopy with Dx of Personal History Of Colon Polyps

[JanRebecca]

Someone (and I forget where I heard this) told me it is acceptable to use Z09 as primary dx code when a patient comes into office with dx of Personal History Of Colon Polyps before a colonoscopy in order to get the office visit paid for. So you would bill Z09 as primary code and Z86.010 as secondary code. Anyone know if this is correct?

 

[LMBENHOFF]

Office visits prior to Screening Colonoscopies (Both High Risk and Routine) are not Medically Necessary according to CMS and post payers. These E&M visits are not reimbursed with a "Z" code of any kind. This is even when a patient is on High Risk medications such as Anti-Coags and the Gastroenterologist wishes to meet with the patient prior to procedure.

Office visits that are reimbursable are when the patient presents with GI symptoms and the provider sees the need to do a Diagnostic Colonoscopy for evaluation of the problem. This office visit and the procedure are considered Diagnostic in nature and Screening benefits do not apply.