Forum - Questions & Answers

Feb 22nd, 2015 - annimagi

Pre colonoscopy office visit for sceening colon

Medicare does not allow us to bill for a pre colonoscopy visit for a screening colon with the thought that our office visit fee is bundled into the payment for the colonoscopy . However, what happens when a patient is seen in our office for his/her colonoscopy, schedules the procedure and then cancels the procedure? We are then left with no payment for time spent with the patient. Can we then bill for the precolon visit since the colon was cancelled? What is the allowed time allotted between the initial office visit and the cancelled procedure? That is, what happens if we see a pt in Feb but they scheduled their colonoscopies in June and then cancels? Can be retrograde bill a pt 4 months after seeing them?

Feb 23rd, 2015 - lhudson 47 

re: Pre colonoscopy office visit for sceening colon

Why would you need to see a pt for a screening colonoscopy in the first place? A true screening has no signs or symptoms. We save our office time for patients that have a complaint and then if they need a colonscopy it would be scheduled.

Feb 25th, 2015 - kroosen 7 

re: Pre colonoscopy office visit for sceening colon

Alot goes into setting up a colonoscopy whether screening or diagnostic, benefits checked, scheduled, consent reviewed and signed, prep explained and prescription given, plus physician has to have an H&P completed. Why would you not charge for that work?

Feb 26th, 2015 - wkurth 1 

re: Pre colonoscopy office visit for sceening colon

QUESTION: Our doctors see a patient in the office prior to a screening colonoscopy. The doctors take a complete
history, do an ROS and a thorough exam. If the only diagnosis is “screening for colon cancer,” can we still bill an
office visit?

ANSWER: For Medicare, unless the patient has symptoms or a chronic condition/disease that has to be managed by the GI provider, an E/M visit prior to the colonoscopy is not covered and will be denied with no patient responsibility.
If you inform the patient ahead of time that this visit is non-covered and they wish to pay for it out of pocket, that is the patient’s option. An advance beneficiary notice (ABN) is not required, but it is sensible to obtain a waiver of some type. If the patient insists that the visit is billed to Medicare, use an unlisted E/M code with GY modifier, which tells carrier it is a noncovered service and the denial shifts to patient responsibility.
For private payors, it will depend whether preventive visits are covered. This is not a consultation since there is no request for a consult, but just a transfer of care since the request is for preventive procedure to be done. Remember
that when billing new patient (99201–99205) or existing patient (99212–99215) E/M codes, there should be a chief complaint. Utilizing E/M visit codes with a screening diagnosis may not make sense to the payor since the patient
undergoing screening should have no symptoms and this is considered a preventive visit, not a “sick” visit. Each payor may have individual policies; for instance, Anthem BC/BS policy is to bill this as a preventive visit 99381–
99397. It is up to each practice to query the most common payors to find out policy and also to check eligibility upon patient scheduling/appointments.


Feb 25th, 2015 -

re: Pre colonoscopy office visit for sceening colon

Per the CPT® surgical guidelines, the E&M services provided are subsequent to the decision for surgery on the day before and/or the day of surgery, including the H&P. I don't understand why you would schedule a patient for the H&P so far out if you know the patient is not having their procedure until June. If the patient comes in for an office visit and it is decided that a screening colonoscopy is going to be done, it has to be done w/in the time frame noted in the surgical package. If the patient decides at the time of service that they want to schedule their colonscopy 3 months down the road, then you hav every right to bill them for the office visit that day. As far as billing for the services that you lost due to their cancellation as long as you are in the insurance guidelines for billing a claim, I would most certinly bill them. most insurance companys have at least a 90 day timely schedule if not 6mos. I know that MCR allows you 1 year to bill for services before they hit you with timely filing. I would certinly check into the timely filing schedule with that patient's insurance and if its w/in their time limits I would bill for the services you provided. Hence going forward I would not set up H&P's for surgical procedures until you know when the patient is going to go forward with the surgery.

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