Wiki Office visit - I am hoping someone can provide

[southpawiv@gmail.com]

Hello- I am hoping someone can provide some insight regarding a gastroenterologist billing an office visit prior to the patient's screening colonoscopy.

Our gastro's conduct an office visit prior to the screening colonoscopy for every patient that is referred to them. Obviously if there are signs and symptoms that can be coded (bloating, change in bowel habit, constipation, diarrhea, etc) we will use those codes as the reason for the visit and the claims are getting paid. However, if the patient is asymptomatic and just being seen for their age appropriate screening our physicians have been using V76.51 Special Screening for malignant neoplasm- colon for the OFFICE VISIT. Is it appropriate to use V76.51 for the office visit or only on the actual procedural claim itself? Medicare will deny our office visit claims when V76.51 is billed as being considered "routine" and included in the procedure. Other coders in our office have then been switching the code to V72.83 Other Specified Preoperative exam but this does not seem appropriate either, yet our claims are being paid.

I would appreciate feedback on 1) Is it appropriate to use V76.51 for the office visit claim or is it only appropriate for the procedure and 2) If Medicare denies an asymptomatic patient's screening office visit because we used V76.51, is it appropriate to use V72.83 or any other code.

Thank You,
Nicole

 

[maddismom]

Yes, use V76.51 and yes Medicare will bundle it with the procedure (unfortunately). It is inappropriate to change the code (to anything else) for reimbursement and good for you for seeing that! You are on the right track.

 

[egraham1827]

The pre-op visit for a screening colonoscopy is included in the global for the procedure, therefore, you cannot bill the office visit. The only appropriate time to bill for the OV is if the patient is experiencing symptoms/problems that require medical decision making.

 

[kathy a]

Can you bill a pre-op visit or not? I am having problems trying to get this across to the place that I work for that you cannot. It is figured into the global for the procedure. One person said that you can using the preventative code for the visit and I believe she is saying only on new patients. But, would this mess up their yearly visit with their PCP. You are saying to use the V72.83 code on the pre-op exam. Is this considered fraudulant coding? Can someone please provide documentation on this subject as to what is or is not allowed. Thanks Kathy Albert

 

[egraham1827]

It is not appropriate to bill the pre-office visit for a screening colonoscopy. Only if the patient is experiencing problems/symptoms is it ok to bill the OV. Think about it, in order to bill any E&M there needs to be a chief complaint- what is the patient's chief compaint if they are only coming in for a screening visit? No complaint = no charge. There are a lot of providers who do this "visit" via phone call so the patient doesn't have to come into the office, but if the patient begins discussing any problems they are having during the screening colt talk, then it does become diagnostic and you are able to bill for it as long as the physician acutally saw & examined the patient. I do not know where this info is online (can't give you a link) but there are many many posts on this forum about this, so you may be able to find some documentation sources to show to your management team if they disagree. Basic E&M coding- no problem, no charge.

 

[djlukes49]

egraham: Does that apply to the HMOs that require an office visit prior to a colonoscopy even if the pt has no symptoms? We've been billing for the office visit because the doctor does take a history and do an exam, but if the pt is asymptomatic, we bill the V76.51 as our only dx. Thanks.