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colonoscopy pre op visit

I am new to gasto coding and have a question. It is my understanding we cannot bill for the pre op visit for a colonoscopy if it is done within 24 hours as the pre op is part of the colonoscopy service. But help me with these scenarios. The patient goes to the family doc because they are age 50+ and want their screening, the family doc refers them to the surgeon who then evaluates and does exam on the patient and schedules them for a screening colonoscopy in 2 weeks. Can we bill for the exam done by the surgeon since the colonoscopy is not scheduled for a couple of weeks out?

Second scenario, the patient went to see the surgeon for rectal bleeding, surgeon decides to do a colonoscopy in 2 weeks, he did an exam and ran blood work to verify his diagnosis. Can we bill for the surgeons visit? Does it make any difference if the patient went to see his family doc first and the family doc referred him to the surgeon for evaluation?

Thanks for any help you can offer I am trying to figure out when I can and cannot bill

Medical Billing and Coding Forum

Colonoscopy with balloon dilatation

Hello fellow coders,

I’m in need of your opinions on the coding of the below op report. Optum is denying my claims stating that the services are not supported due to no documentation within the op report that the colonoscope went to the cecum. Per CPT book the definition of a colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include the examination of the terminal ileum or small intestine proximal to an anastomosis.

A digital rectal exam was performed revealed no masses. After adequate IV sedation given, Olympus pediatric colonoscope was inserted into the patient’s rectum and advanced around the ileocolonic anastomosis. The patient had scarring with the ascending colon from previous Crohn disease. The anastomosis was strictured down and the scope could not be advanced through this area. A 12-13.5-15 mm wire-guided balloon was advanced through the anastomosis. The balloon was inflated to 12mm held there for 1 minute. The balloon was inflated to 13.45 mm and held there for 1 minute. The balloon could be advanced through the anastomosis. Some active inflammation and ulceration was noted within the terminal ileum. Biopsies were obtained from the terminal ileum. The remainder of the ascending colon, hepatic flexure, transverse colon, splenic flexure, descending colon, sigmoid colon and rectum were normal.

Coded As:
:confused:
45386
45380-59

Thank you in advance for your opinions.

Medical Billing and Coding Forum

Here’s What You Need for Colonoscopy Coding Prep

March is national colorectal cancer awareness month, and a perfect time to check your colonoscopy coding. Colorectal cancer is the third most common cancer in men and women in the United States, the Centers for Medicare & Medicaid Services (CMS) reminds us in this week’s MLN Connects (March 14, 2019). Getting screened for colorectal cancer […]

The post Here’s What You Need for Colonoscopy Coding Prep appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Healthy Colonoscopy follow up…medical necessity??

Pt comes back in for results of the colonoscopy, they have already come in for a pre-appt that wasn’t billable because they were healthy, now they are coming for their results…unnecessary? Thanks for your thoughts..my thought is send him a letter and see pts that need to be seen. :confused:

HISTORY OF PRESENT ILLNESS: ….. is a 55-year-old male who
comes to the office on 01/31/2019 for a followup for a
colonoscopy. The colonoscopy, the patient states that he had a
good prep. It did not make him sick. He does not remember the
procedure, and he had no ill effects from the procedure. He is
in zero type pain at the present time.

PHYSICAL EXAMINATION: General: Demonstrates a 55-year-old
white male, oriented x3, pleasant and cooperative.
Vital Signs: Temperature 97.6, pulse 57, respirations 20, BP of
132/78, 6 feet tall, 248 pounds, 97% on room air. 0 pain at the
present time.
Lungs: Clear to auscultation bilaterally. No rales, rhonchi or
friction rubs. No wheezing. Normal respiratory effort. No
shortness of breath.
Heart: Regular rate and rhythm. No S3 or S4 sounds are heard.
No chest pain during the examination. No bruits heard over the
carotids or aorta. No swelling to the lower extremities.
Abdomen: No masses in the abdomen. No tenderness. No
organomegaly. No evidence of hernia.

We reviewed the following material for this visit.

CURRENT MEDICATIONS: We reviewed his medication list.

IMAGING: We reviewed the chest x-ray from 01/04/2019.

LABORATORY: We reviewed his blood work from January 4, 2019.

We reviewed his colonoscopy from 01/25/2019, which demonstrated
2 polyps. We reviewed the pathology report from 01/25/2019,
which demonstrated the 2 polyps to be adenomatous polyps. One
is a pure adenoma, the other one was a tubular adenoma. No
evidence of dysplasia, metaplasia or cancer.

We reviewed the consultation from 01/02/2019.

IMPRESSION: We have a healthy 55-year-old white male who grows
adenomatous polyps.

RECOMMENDATIONS: A repeat colonoscopy in 2 years.

Medical Billing and Coding Forum

discontinued colonoscopy

Where is the best place to find current rules on coding a screening colonoscopy that was discontinued because the provider was unable to advance passed the sigmoid colon due to tissue obstruction. A biopsy was done at the sigmoid colon. I have found things that say add modifiers to the colonoscopy code and other places say code as a sigmoidoscopy. Thank you!

Medical Billing and Coding Forum

00813 – Screening Colonoscopy w/diagnostic EGD

Hello,

Curious to know, and where to find a policy on coding for Anesthesia for EGD and Colonoscopy same day when the patient is having a screening colonoscopy and a diagnostic EGD. I have been coding 00813 w/Z12.11 and the diagnostic code for the EGD w/any co-morbidities the patient may have for MAC cases. BCBS is partially paying the claim. The patients are being told that the claim needs to be billed as screening colonoscopy in order for it to be paid with no patient responsibility as they have a benefit for screening.

Can we bill in this situation a 00812 and a 00731 or does it have to be the 00813. Is anyone else having this issue with their claims?

Thanks in advance!

— Valerie

Medical Billing and Coding Forum