Can a consultation be done on beneficiaries in need of screening services, for example, a patient undergoing a screening colonoscopy?
A referral that does not ask for advice or opinion and only asks for a screening procedure to be done does not meet the requirement for a consult. For example, 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. These E/M services, to include consultations, are not separately payable. While the law specifically provides for a screening colonoscopy, it does not also specifically provide for a separate screening visit prior to the procedure. Although no separate payment can be made for these visits currently, the fee schedule payment for all procedures, including colonoscopy, contains payment for the usual pre-procedure work associated with it. This reflects the principle that each procedure has an evaluative component.
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