Pre-colonoscopy visit

Is a preoperative physical performed prior to a screening colonoscopy considered part of the colonoscopy, or is it separately billable? The office visit is not the same day as the colonoscopy, but it does have the same diagnosis. If it is billable, how should we code for it? Would it be a consult, since another doctor referred the patient to me?

This is usually not a billable service. Colonoscopy services are assigned a “000-day” global period. Chapter 6 of the National Correct Coding Initiative manual states, “If a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and should not be reported separately as an E/M service. However, a significant and separately identifiable E/M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.”

An office visit might be reported if, in the usual pre-procedure work, the physician uncovers a diagnostic reason for the colonoscopy or an indication that precludes performing the procedure.

Punch biopsy

Is CPT code 11100 appropriate for any size punch biopsy (3 mm to 8 mm)?

Yes. Code 11100 may be reported for a single or first biopsy, regardless of size. However, you should always consider location. If a punch biopsy is taken of certain areas, such as the lip (40490), external ear (69100) or eyelid (67810), it is appropriate to report the code for that specific body area.

Wound repair global periods

I recently saw a patient with an open wound that required simple repair. The patient could not clean and redress the wound himself, so I saw him daily for the next few days for cleaning, application of topical medication and redressing, until the wound began to heal. How should I code this care?

The wound repair codes typically have a 10-day global period, so the follow-up services you describe are not reimbursable. Most payers will deny any related services during the global period except those involving a complication that requires a visit to the operating room.

Cryotherapy for warts

Editor's note: While this department attempts to provide accurate information and useful advice, third-party payers may not accept the coding and documentation recommended. You should refer to the current CPT and ICD-9 manuals and the Documentation Guidelines for Evaluation and Management Services for the most detailed and up-to-date information.