Wiki Welcome to Medicare Colonoscopy Screenings

[d_imparato]

Hi All,

I work for a Rural Health multi-specialty practice group. I have a Medicare claim that has been denied for not medically necessary. This is a surgeon who was consulted to see this patient strictly for a screening colonoscopy.
The patient had never had a colonoscopy before & no presenting symptoms either. Medicare effective date & DOS only 51 days apart. The dictation does not state this is a Welcome to Medicare colonoscopy visit.
The charges were a level 3 office visit & V76.51.
Medicare denying for medical necessity for Dx V76.51 but as stated there isn't any symptoms to code. Is there a different CPT code for a Welcome to Medicare visit that I am missing?

Thank you all for any insight on how to code this Welcome to Medicare Colonoscopy screening OV.

LImparato, CPC, AAS

 

[cynthiabrown]

if only being seen for prior to colonoscopy, it is not billable. But you can bill IPPE if appropriate. Google documentation needed for Welcome to medicare

 

[mitchellde]

The V76.51 is not a dx code to use for an office visit. When you use a screening dx code it needs to link to the screening procedure code. If the patient has already been assessed for the necessity for a screening then it is correct that you cannot charge a visit prior to the procedure.

 

[d_imparato]

Thank you both for your replies. I didn't think you could bill but am having terrible time convincing the provider. He is wanting to know of a way to charge for his work-up. I explained the only way is if there are symptoms to report or he finds additional problems. However, if he is only seeing the patient for the screening then the office visit is integral of the colonoscopy. Am I correct?
LImparato, CPC, AAS

 

[afalcon@dhcla.com]

This would be considered a NO VISIT

 

[cynthiabrown]

tell doc his pre op work is included in rvu for procedure.......sometimes that will make them feel better. sometimes not!