Wiki Capital Blue Cross - Colonoscopy

[JanRebecca]

When billing Capital Blue Cross - what CPT code do you use to bill a screening colonoscopy? I used ICD 10 Z12.11 as primary code for Colorectal Cancer Screening and CPT code 45378 for Colonoscopy/Screening. It's been 10 years since his last one.

Patient is saying that anesthesia sent him a bill - when it should have been covered 100% as screening - our part of the bill was! He called the insurance company and they are saying that because we billed as diagnostic so did anesthesia. We got paid as a preventive service - HOW WOULD the anesthesia know how we billed? THe OP report clearing says it was for a screening.

Any advice is appreciated.

 

[trose45116]

Is this a commercial or medicare advantage plan.


can you post the op note?

 

[tdeberry@winanes.com]

Anesthesia for Colon

I am not sure about in your case, but when one of my docs does anesthesia for a colonoscopy we code the anesthesia directly from the OP note from the surgeon. Anesthesia is coded by using the procedure code from the OP note, and the proper anesthesia crosswalk code to that procedure code. Again without know anymore details I cannot tell you why the anesthesia claim was not processed by BC as yours was, but I can tell you this does happen as an error on the part of BC, at least to my practice, quite often. I would suggest reaching out to the anesthesia group and asking if you can go over with them how they billed, and then calling BC, or maybe they will call for the patient if their claim was not processed correctly.

Also, the dos may play some part in this as well, since the new anesthesia endo codes started on Jan 1st 2018 our local BC has been processing claims incorrectly, they are not following medicare guidelines when it comes to them, same goes for the PT modifier.

 

[GI CODER]

Our physicians do the moderate sedation themselves, so I code both the procedure and the moderate sedation. If I don't add the preventive services modifier 33 to the 99152, or the PT to the G0500 sedation codes, the coinsurances &/or deductibles get applied to the sedation payment processing. Have the anesthesiologists try adding the appropriate modifier and see what happens.