Medicare Compliance & Reimbursement

Hint: Modifiers are key to collecting for screening-turned-diagnostic colonoscopy Could your medical practice afford to leave several thousand dollars in your MAC's office each year? That's what some practices are doing by not coding and billing properly. Check out the following three questions and their answers, to determine whether you're collecting every dollar you're owed. Question 1: Your physician discovers several polyps while performing a screening colonoscopy and removes them using the snare technique. Should you report the screening colonoscopy G code or the diagnostic colonoscopy 453xx code to collect for the screening-turned-diagnostic procedure? Answer 1: In this case, you should report the colonoscopy with polyp removal via snare technique (such as 45385, Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s], by snare technique) with modifier PT (CRC screening test converted to diagnostic test or other procedure) appended to 45385. Modifier PT tells the [...]