GI E/M Coding

Help please. I am working on GI E/M coding.

If a patient is referred to the GI doctor with no symptoms for a screening colonoscopy and the GI doctor sees the patient and schedules the colonoscopy a month later, per Medicare the visit is not billable since the pre-work is included in the minor procedure (the colonoscopy).

If the patients are not Medicare, would you bill for a low level E/M visit? I read some information that says non-Medicare payers may pay for a screening visit. But is this wrong to bill for these? The diagnosis codes are all Z12.11 Encounter for Screening for Malignant Neoplasm of colon, so wouldn't they kick out if they were billed and not payable by non-Medicare?

And the G codes come in for the actual procedure itself for Medicare patients, correct?


Mary Flanery, CPC, CBCS, CHC
Quality Review Specialist
Baltimore, Maryland



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Comments

  • We bill everyone for this “surgical consultation”. What each plan does with this encounter is processed according to the patient’s plan benefits. Medicare denies as PR due to the diagnosis being screening and pre-work for minor procedure but other plans will pay for this encounter. You have to bill everyone the same regardless of claim processing and payment/denial.

    Christie Thomas CPC
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    Fort Scott, Kansas 66701
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  • edited May 2017
    Z01.818 pre-procedural exam. No issues getting paid. Usually 99202 if new pt or 99213 for established patient if there are no other issues addressed. Usually. All depends on documentation.

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