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CO Rocky Mountain Gastroenterology Colonoscopy Billing: What You Need To Know 2015
Get CO Rocky Mountain Gastroenterology Colonoscopy Billing: What You Need To Know 2015-2024
Colonoscopy Billing: What you need to know The Affordable Care Act that passed in March 2010 allowed for several preventative services, such as colonoscopies, to be covered at no cost to the patient.
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Cpt FAQ
The 2018 CPT code book introduced 2 new codes to report anesthesia during colonoscopy: 00811 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified. 00812 Screening colonoscopy.
A colonoscopy is considered preventive screening if the patient doesn't have any gastrointestinal symptoms and no polyps or masses are found during the colonoscopy. The Affordable Care Act (ACA) considers preventive services “essential health benefits” and requires insurance companies to pay all associated costs.
Modifier “-53” (discontinued procedure) must be appended to any procedure code submitted when billing for a failed colonoscopy attempt.
A screening colonoscopy will have no out-of-pocket costs for patients (such as co-pays or deductibles). A “diagnostic” colonoscopy is a colonoscopy that is done to investigate abnormal symptoms, tests, prior conditions or family history.
A visit prior to a screening colonoscopy for a healthy patient is not billable. If a patient is referred to our office for a screening colonoscopy and the patient is on , can we bill for the visit? Yes.
HCPCS Code for Colonoscopy consultation performed prior to a screening colonoscopy procedure S0285.
At the consultation appointment, you will first watch a presentation explaining to you what a colonoscopy is, risks & benefits to the procedure, options you may have, prep information and what to expect on the day of you procedure.
Q. Can a provider bill an E&M visit if a beneficiary is referred for a screening colonoscopy? A. A provider preparing to perform a screening colonoscopy cannot also bill for a pre-procedure visit to determine the suitability of the patient for the colonoscopy.
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