Gastroenterology Coding: V72.83 Is The Right Choice For Pre-colonoscopy Visit

By Author: erinarticle
Total Articles: 105
Comment this article

When we bill 99203 or 99204 with diagnosis code V76.51, we end up getting denials. The insurance says we cannot bill a screening with these CPTs since they are medical. What is the right way to go about this particular situation?


If it is a pre-colonoscopy visit, Medicare and some commercial carrier think about the service as covered in the colonoscopy procedure and not medically necessary as a separately billable service. For insurance the carrier that cover this service, you should bill as a pre-procedure visit and report V72.83 (Other specified preoperative examination) as the diagnosis.


Here's a tip to help you here: You should report the service for what it is. You're not screening for colon cancer at the pre-procedure visit itself, which is not done until the patient actually has the colonoscopy.


A note of caution: You should be careful with Medicare. If there aren't other things going on with the patient, then a routine pre-colonoscopy visit is not a billable service. If the patient is asymptomatic and has no medical issues managed by the gastroenterologist, ...
... then the service wouldn't be considered medically necessary by Medicare and some other payers. But then if the patient is symptomatic or has a medical condition that must be managed during this visit in preparation for the colonoscopy procedure, then it should be covered, as per these Medicare guidelines.


For more on this and for other specialty-specific articles to assist your Gastroenterology coding, sign up for a good medical coding resource like Coding Institute.