Wiki Screening Evals for Colonoscopy

[s7mich@hotmail.com]

I am trying to figure out what E/M to charge for a screening Colonoscopy. When you send a V76.51 to some commercial insurance companies they want a preventative eval. Any suggestions to this matter. I am a little confused. Thanks

 

[mitchellde]

V76.51 is a code to be used when the screening procedure takes place not for the evaluation for the procedure. If the patient had already been evaluated by the PCP for a preventive encounter and had determined that the patients meets the parameters for the screening procedure, then this eval has already been performed and it cannot be charged again. If the patient has not had a yearly well visit to determine if the meet the criteria then it is a preventive yearly. If the patient has been scheduled by the PCP office to have the screening performed by your provider then the only thing you can code is the screening procedure.

 

[s7mich@hotmail.com]

What if we are seeing the patient for the screening and not the pcp how would you code the Eval then. This gets a little confusing..If the patient presents to our office with no problems and is over the age of 50 and needs a scope then how would you code the eval and dx if you should not use V76.51 as a dx

 

[jdibble]

What if we are seeing the patient for the screening and not the pcp how would you code the Eval then. This gets a little confusing..If the patient presents to our office with no problems and is over the age of 50 and needs a scope then how would you code the eval and dx if you should not use V76.51 as a dx

If the patient is presenting to the office for an evaluation prior to a screening colonoscopy, this visit is usually not billable. It is included in the global for the colonoscopy. If the patient is seen for an eval and it is determined that the procedure cannot be done for some reason or there is a reason to do a diagnostic colonoscopy (i.e. rectal bleeding) rather than a screening, then you would bill the E/M using the diagnosis code that represents those reasons.

For further information:
http://www.palmettogba.com/palmetto/providers.nsf/vMasterDID/8EELDY5430

Hope this helps.

Thanks,