billing for OV prior to screening colonoscopy if pt is on coumadin

Can we bill for an OV prior to screening colonoscopy if pt is on coumadin? What code is appropriate for OV?

re: billing for OV prior to screening colonoscopy if pt is on coumadin

The patient may be at high-risk for the screening procedure due to other conditions (i.e., COPD, medications, etc.) that affect the pre-operative instructions given to the patient or how the procedure is performed, however, the consideration given to these risk factors is inclusive in the usual “pre-operative” work associated with the procedure. Reporting an E/M service with a diagnosis code associated with one of the patient’s risk factors implies that the GI physician saw the patient in order to diagnose or manage the illness identified and that is not the case. The GI physician is seeing the patient in order to determine the suitability of the patient for the screening procedure and CMS has stated that these visits are not billable.

The following FAQ was posted on the CMS website:
Evaluation and Management Visit prior to Screening Colonoscopy
Q. Can a provider bill an E&M visit if a beneficiary is referred for a screening colonoscopy?
A. A provider preparing to perform a screening colonoscopy cannot also bill for a pre-procedure visit to determine the suitability of the patient for the colonoscopy. There E/M services, to include consultations, are not separately payable. While the law specifically provides for a screening colonoscopy, it does not also specifically provide a separate screening visit prior to the procedure. Although no separate payment can be made for these visits currently, the fee schedule payment for all procedures, including colonoscopy, contains payment for the usual pre-procedure work associated with it. This reflects the principle that each procedure has an evaluative component.