Wiki Coding screening colonoscopies for Medicaid patients

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marymurk

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The physician performed a screening colonoscopy on a patient who is covered under Medicaid. I selected 45378 with dx code of v76.51; however, when abstracting in the computer, an error message came up saying that this is not acceptable. I then researched and found something from 2002 which said that you could use G-codes for Medicaid screening colonoscopies. I am totally confused at this point and would appreciate any help!:(:confused:
 
Medicare uses HCPC II codes for many things that also have CPT codes. The screening colonoscopy is one of those. So yes for Medicare you need the G code for the screening as long as there was noting else performed such as polypectomy.
 
Generally if you use a "V" code for the diagnosis and no polyps were found then you would use the "G" code for the procedure. So for V76.51 use the G0121, for high risk like V16.0 or V10.05 use the G0105. Again the G code is only if no biopsies were taken. Most commercial payers will accept that coding as well.
 
Our state Medicaid system does require that we use G codes for high and low risk screening colonoscopy.
 
I bill Medicaid in NY via Epaces and have not had any trouble with 45378/v76.51
 
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