Wiki Office Visit prior to Screening Colonoscopy

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gibsona

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I realize this has already been covered many times in past threads, and I have gone through them all.

I understand that we should not be billing Medicare for an evaluation and management service prior to a screening colonoscopy, however my dillema is this: Our GI doc has been seeing patients and billing new and established patient visits using V76.51 as a diagnosis code and Medicare has been paying. I cannot find any solid documentation from Medicare or CMS that this is not a payable service so I cannot find any proof to bring to him or his office staff that this should not be done. All of the links to CMS or Medicare are broken and any other information I can find online is all from coding websites or gastro.org, nothing directly from the source.

Can anyone please provide me with documentation from CMS and/or Medicare that states that we are not to bill for a e&m service prior to screening colonoscopy if the patient presents with no GI symptoms?

Thanks
 
You should search the posts as I know somewhere the reference for this has been posted. Also you cannot use the V 76.51 code for the E&M since that is the code for the procedure. You did not do the screening at the office visit . Icd-10 CM guidelines will tell you that when you use a screening dx code a screening procedure must be performed. So if you take away the dx code then you have no dx to use for the E&M .
 
I have already searched the previous threads and anywhere that there is an actual link to CMS or Medicare the link is old and broken. I cannot find the documentation anywhere through my Medicare contractor (Novitas) or through CMS/CMS Archives.

I do understand that this cannot be billed this way, however I'm looking for the proof to take to the doctor, his staff, and the billing manager to be able to show them since he is billing the services this way and getting paid. We actually came across this doing a random audit of his charts for a different reason and while both myself and my colleague agree that he shouldn't be doing this, we need proof to be able to get it to stop.

I actually called Medicare twice today as well, hoping they would direct me but instead I was told that this was not paid in error and they cannot tell me why they are paying the claims this way. I fear that the staff answering the phone is also misinformed and my provider is at audit risk because of this - but again, can't find the solid documentation to show him!
 
Another "pre colonoscopy" question

anyone have any response to their doc's who want to bill based on counseling for these "pre colonoscopy" visits because we bring our patients in if they have other diagnoses (copd, diabetes etc) that the doc's need to adjust meds on. since they've been told these are billable now they think they can bill based on "time" for "counseling" these patients on how to adjust their meds????
 
I, too, was getting paid for these visits. This makes it difficult to explain to the physicians. Here is the way I approached it:

Let's audit this office visit.
  • What is the chief complaint?
  • What is the location, timing, quality, context, duration, severity, associated signs & symptoms and modifying factors?

This will begin to show how it would never stand up in an audit, as there is nothing wrong, so there is no medical necessity for the office visit.
 
We have been billing with a "V72.83" and "V76.51" only for new patients. My Doctors do not want to preform a colon on a patient they have never seen and do not know anything about them. As for return patients we do not require a pre-op office visit.
 
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