Wiki Pre colonoscopy office visit

[lindam@caricures.com]

We have a policy in our practice to see patients in the office for a pre colonoscopy visit. The NP goes over history, explains procedure etc. Some insurance companies pay, some don't. Some patients complain that it should be considered part of the screening colonoscopy and therefore not be charged towards their deductible. I am looking for any input on how you submit these claims. Usually NP uses 99204 and then lists all the issues as dx codes, with the encounter for screening colonoscopy as the last Dx code. I have found that some insurances with pay if the Z12.11 is used as the primary Dx.

Any thoughts?

 

[TamGIGal]

We bill out pre colonoscopy visits too as long as the visits are not on the same day as the colonoscopy. There is a colonoscopy consult code S0285 that we use and most insurances cover this, other than any Medicare or Medicaid plans. We use 99202 or 99212 for any plan that doesn't cover the pre visit on straightforward, low risk patients as there isn't a Problem/Complexity nor any Elements of MDM.

I hope this helps.

 

[sls314]

We have a policy in our practice to see patients in the office for a pre colonoscopy visit. The NP goes over history, explains procedure etc. Some insurance companies pay, some don't. Some patients complain that it should be considered part of the screening colonoscopy and therefore not be charged towards their deductible. I am looking for any input on how you submit these claims. Usually NP uses 99204 and then lists all the issues as dx codes, with the encounter for screening colonoscopy as the last Dx code. I have found that some insurances with pay if the Z12.11 is used as the primary Dx.

Any thoughts?

I would question the use of a 99204 for most patients who are presenting to have a screening colonoscopy. Is anyone reviewing the documentation to ensure that the E/M level is supported?