OV with scheduled colonoscopy

In what type of situation can an seperate E/M code be billed when the pt shows up for a scheduled colonoscopy? The general surgeon is meeting the patient for the first time at the hospital...but the procedure was already scheduled. Isnt his evaluation part of the procedure?

You are correct

If this is a screening exam then the "meet and greet" is part of the global fee. If the patient has pain/bleeding, etc then you could do a visit and the procedure with a -57 (although since the patient is already prepped the decision was already made.)

e/m w/colonoscopy

If it wasn't planned it would need a 25 modifier, not 57 b/c it has no global. If it was a planned procedure you can't bill an E/M.

E/m with Colonoscopy

These patients are all coming in with symptoms. These are not screening colonoscopies. After researching online, I've come across several people who say because Pt has symptoms, a new pt visit "may" be appropriate. They don't give anymore specifics than that, nor do they specify if that visit should be done ahead of time, or same day. All written guidelines I find are specific to E/M's with SCREENING colonoscopies. Does anybody have anything concrete I could take to my surgeon? Thank you!

Tell her this

See the patient in the office, gather a history and physical, bill as consult (until Dec 31 if referred by another doc) or new patient then schedule the colonoscopy. Prepping for a colonoscopy is not without risks and not a lot of fun so the determination that the test is appropriate should be made at the time of a visit not over the phone before the patient/doctor relationship is established. What if you order a prep on a patient whose pain is from acute diverticulitis and they perforate? What if they have CHF and your prep sends them into heart failure? What if their pain is in the RUQ and they really needed an ultrasound?

diagnostic colonoscopies

If an "established" patient presents for a scheduled colonoscopy because on a previous encounter the medical necessity was determined, all interval questions pertinent to performing the procedure are included in the procedure.
If, the patient has a co-morbid condition that requires evaluation before doing the test, an E/M level of medical necessity may be billed with the -25 modifier.
Bottom line, it is the physician's decision to do a separate and distinct E/M service relevant to issues above and beyond what is included in the procedure. He must justify the level of E/M code and medical necessity based on clinical judgement.

same day...

I work in a GI office. It has always been my understanding that in general, office visits (E/M) and colonoscopies will not be separately reimbursed if done on the same day.

We have a policy that the patient must be seen in the office before having a colonoscopy scheduled. While I've been told at seminars that pre-colonoscopy visits are not paid, I've never had a denial for the office visits, whether they have symptons for a diagnostic procedure or if they are screenings. I know a lot of offices don't have this sort of policy and meet patients for the first time right before the office visit to save time, but as was already said, the "meet and greet" is included in payment for the colonoscopy.

There is a certain amount of work that has to be done before a procedure no matter what, and if its done over the phone no one is getting paid anything for that. So why not bring the patient in beforehand for a short visit AND get paid for your work?

Also, we have NEVER been paid for an inpatient visit AND inpatient colonoscopy when done on the same day. We only get paid for the procedure.

Ov with scheduled colonoscopy

Great help everyone, thank you! This will be helpful when meeting with this surgeon today.