Screening Colonoscopy and Evaluation and Management Service on the Same Day

Published 12/11/2020

Typically, patients referred for a screening colonoscopy do not have signs or symptoms that support a diagnostic colonoscopy. The physician performing the colonoscopy may wish to see and evaluate the patient prior to the screening colonoscopy. In this case, the evaluation and management (E/M) visit is generally not separately billable.

Even though some patients may be at high risk for the procedure due to concurrent conditions that may affect the decision to perform the procedure, the patient evaluation for these risk factors is included in the usual pre-service work associated with the screening colonoscopy.

A separate E/M service may be submitted for patients that are referred for a screening colonoscopy when either of the following scenarios occurs:
  • All the required components of the E/M are documented and based on this evaluation the physician decides not to proceed with the procedure; or
  • All the required components of the E/M are documented and the physician determines the patient has signs and symptoms that warrant a diagnostic colonoscopy instead of the screening colonoscopy
It is also important to remember that when a screening colonoscopy detects a lesion or growth resulting in a biopsy or removal of the growth, the appropriate diagnostic colonoscopy with biopsy or removal code must be submitted rather than the screening colonoscopy code.

Resource: CMS Internet Only Manual, Pub. 100-4, Chapter 18: Preventive Services Manual (PDF, 1.22 MB), Section 60.

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