decisionhealth Newsletters, Coder Pink Sheets - 2004 Issue 1 (January)
Medicare now says you can bill patient for E/M visit prior to screening colonoscopy
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Article Overview
This article reviews a Medicare policy clarification affecting pre-procedure evaluation and management visits associated with screening colonoscopy. It is useful for physician practices, GI coders, and billing staff who need to understand the general coverage status, patient billing considerations, and related documentation issues discussed by CMS and coding consultants.
Why This Topic Matters
The topic affects whether a practice may seek payment from the patient for a pre-service office visit tied to a screening colonoscopy and how to handle coverage-related paperwork and claim processing.
What You Will Learn
- How Medicare characterizes a pre-procedure evaluation and management visit before screening colonoscopy
- Why coverage status matters for billing workflow and patient responsibility
- What general documentation and notice considerations are discussed in relation to noncovered services
- How the article frames differing interpretations among Medicare, consultants, and coders
Who Should Read This
- Medical coders
- Billing staff
- Physician practices
- Gastroenterology practices
- Compliance staff
Codes Discussed
Modifiers Discussed
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