Author Topic: How to bill E/M visit when patient wants a screening colonoscopy referral?  (Read 1588 times)


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If a patient comes in to a provider's office to obtain a referral for a screening colonoscopy how is the E/M billed to the patient's insurance? 
It is not a preventive visit as no preventive exam is done but it is not medical either as the patient has no signs or symptoms of a medical condition but does meet the 50+ age requirement for a screening colonoscopy.  Would you bill the medical E/M, i.e. 99212 with ICD-9 V76.51? Or, if patient does have a family history but still no symptoms would you use ICD-9 V16.0?


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It helps to know from what aspect you are asking the question.  Are you the biller or the coder, or both?  I am not a certified coder and I obviously don't have access to the patient's file.  From what you are describing below it seems that it would be appropriate to bill the E&M code using either or both of the ICD9's that you mentioned depending on whether or not there is a family history.  But then I'm not sure since the dx V76.51 indicate that it's a screening and the E&M isn't part of the screening, it is to order the screening??   HMMMMM.......

Input from any certified coders out there would be appreciated.   ;D
« Last Edit: March 31, 2014, 08:16:26 PM by Michele »
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Here is a link about this, look at question # 9, for starters:

Another way to look at it is this:

Do you have two out of three elements needed to bill an E/M code, and most importantly, a CC? If you don't have a CC, you don't a billable E/M code.