Is E/M Possible Pre-Colonoscopy?

February 3, 2010

Question: A local family physician refers a patient to our gastroenterologist for a diagnostic colonoscopy. The patient reports to the practice and meets the gastroenterologist for the first time. After answering some patient questions during a brief introduction, the gastroenterologist performs a diagnostic colonoscopy with brushing. The patient had never met the gastroenterologist before. Is the time he spent with the patient pre-screening a separate E/M?

Answer: Do not report a separate E/M for this encounter. On the claim, report 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) for the service.

Explanation …

When a patient reports to the gastroenterologist for a scheduled procedure, the pre-service time is almost always included in the procedure code. It does not matter if the patient has been to your practice before.

There are exceptions to this rule, but an allowed E/M service before a scheduled diagnostic colonoscopy is rare, and judging by the details of your description, this precolonoscopy service would be rolled into 45378.

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