Medicare Compliance & Reimbursement - 2019 Issue 6
Specialty Spotlight: Know When, When Not to Use E/M Codes for Pre-Colonoscopy Screenings
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Article Overview
This article covers common coding questions in gastroenterology related to pre-colonoscopy screening visits. It summarizes Medicare contractor guidance, discusses when evaluation and management services may or may not be reported, and outlines how payer differences and related diagnosis coding considerations can affect reporting. It is aimed at coders, billing staff, and gastroenterology practices that need to understand the general scope of pre-procedure visit reporting.
Why This Topic Matters
Pre-colonoscopy encounters are a frequent source of coding uncertainty, especially when deciding whether a separate evaluation and management service applies. The article helps readers understand the general policy landscape across Medicare and non-Medicare payers so they can better evaluate documentation and billing scenarios.
What You Will Learn
- How pre-colonoscopy screening visits are discussed in relation to evaluation and management reporting
- What Medicare contractor guidance says about pre-procedure visits
- Which general circumstances may lead to a separately reportable office or outpatient visit
- How diagnosis coding considerations may come into play before colonoscopy
- How payer policy differences can affect reporting of pre-colonoscopy services
Who Should Read This
- Medical coders
- Billing staff
- Gastroenterology practices
- Compliance personnel
- Revenue cycle professionals
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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