decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 2 (February)
Post-colonoscopy visit: Necessity should dictate charge
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Article Overview
This article examines whether routine follow-up visits after colonoscopy or other GI endoscopy services should be billed when there is no global period issue but medical necessity may still be in question. It discusses how Medicare and private payer medical necessity standards affect payment decisions, and it is aimed at GI coders, billers, and practice staff who need to evaluate post-procedure E/M reporting.
Why This Topic Matters
The article helps readers distinguish between a visit that happens after a procedure and a visit that is separately supportable for payment. That distinction affects compliance, reimbursement, and how practices handle routine post-colonoscopy communication and follow-up.
What You Will Learn
- How medical necessity affects billing for post-procedure office visits
- How Medicare and private payer standards may differ in evaluating follow-up services
- Why a routine follow-up communication may not always support separate reporting
- How GI practices think about post-colonoscopy results review and treatment planning
Who Should Read This
- GI coders
- Medical billers
- Practice managers
- Compliance staff
- Gastroenterology clinicians
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