decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 2 (February)
Post-colonoscopy visit: Necessity should dictate charge
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Article Overview
This article explains how medical necessity affects whether a routine post-colonoscopy or post-endoscopy visit should be billed. It is aimed at GI coders, billers, and physician practices that need to balance global-period concepts, payer policy, and documentation when deciding if a follow-up E/M service is separately reportable. The discussion cites Medicare guidance and contrasts it with private-payer medical necessity standards.
Why This Topic Matters
Understanding the difference between a permitted service under global-period concepts and a separately payable service under medical necessity requirements helps prevent inappropriate billing and claim disputes.
What You Will Learn
- How medical necessity affects billing decisions for follow-up GI visits
- Why a service may be documented yet still not meet payer payment requirements
- How Medicare and private payer medical necessity concepts are discussed in the context of endoscopy follow-up
- What kinds of post-procedure findings can change the relevance of follow-up care
Who Should Read This
- GI coders
- medical billers
- revenue cycle staff
- physician practice managers
- gastroenterology practices
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