Wiki Visit before Screening Colonoscopy

[MichelleCPC]

Please help with a patient of ours we referred to a general surgeon for a Screening colonoscopy. On our referrral form we also listed that the patient has a HX of breast cancer. Our local surgeon requires a visit before the actual procedure to take a history from the patient. Patient went to that visit, it was billed with 99203 with the diagnosis code of V76.51. Our patient has to pay the full price of the bill because medicare denied it. It seems to me that the billing is incorrect. Because the patient was referred there from our office is 99203 correct? Medicare is not going to pay the V code as primary in this case. Thank you for any help.

 

[Barbara A. Love]

screening colonoscopy and visit beforehand

There must be clearly documented medical necessity in order to bill a visit prior to a screening colonoscopy. "Taking a history" is included in the procedure. There could be medical necessity to see the patient prior to a screening if the patient was a diabetic and they had to "adjust" their insulin. Or another scenario would be if the patient was on plavix, that would need to "adjusted or stopped" prior to the procedure. Other than for those scenarios, you shouldn't bill a visit prior to the procedure. Where is the justification for the visit. There nothing wrong with the patient, they are coming to the surgeon for a screening, not a problem or illness.

 

[TEVANS68]

Can someone provide me with a link to the publication within Medicare that states the pre op E/M is bundled with the procedure for G0121 or G0105 with dx V71.51? I know that when the E/M is performed on the day of the procedure it would not be allowed, however, I am unable to find documentation where the pre-op visit is not allowed performed prior to the procedure date. Neither code has a global period.