General Surgery Coding Alert

Question: Our surgeon performed a screening colonoscopy for a 65-year old Medicare patient, but during the procedure, they excised two polyps and submitted them for biopsy. How should I code the case?

Mississippi Subscriber

Answer: First, you need to use the screening ICD-10-CM code as the reason for the test: Z12.11 (Encounter for screening for malignant neoplasm of colon). The screening code indicates that you’re performing the colonoscopy in the absence of signs or symptoms (including history, such as history of colonic polyps). You should also be aware that Medicare has a frequency limit of once every 10 years for a screening colonoscopy.

Next, you need to report the procedure code that indicates how the surgeon excised the polyps, such as 45385 (Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique). That’s not the code Medicare will expect for a screening colonoscopy, which is G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).

Modifier help: You should append modifier PT (Colorectal cancer screening test; converted to diagnostic test or other procedure) to the procedure code (such as 45385) to alert Medicare that the surgeon converted a colon cancer screening to a diagnostic service. Using the modifier means that Medicare will process the claim without a patient copay or deductible.

Caveat: Your question doesn’t supply a lot of specifics, such as the surgical method for excising the polyps, or the patient history. Changes to any of those facts could change how you bill the case.