Wiki Colon screening

[DWertel]

Coding CPT code 45378 with V76.51 dx only. Pt has commerical ins. Do I still attach a 33 modifier even though there is only one dx code. Please help. I was online for two hours and could not find the answer.

 

[cjrottum]

You should not have to use the modifier since this is commercial insurance the code would be 45378 for screening (no biopsies taken) so V76.51 is all you need.

 

[mitchellde]

Since 45378 is a diagnostic procedure and not by definition a screening then yes you do append the 33 modifier. However many commercial carrier do accept the G code for screening colonoscopy.

 

[Jess1980]

Screening colonoscopy and modifier 33

No you will not need Modifier 33 for screening colonoscopy. You are telling them its a screening with your DX code V76.51.

 

[mitchellde]

This is why the 33 was created, that is for procedures that are not by definition preventive, but are performed for preventive reasons, and the service meets the definition for preventive coverage as an Aor B service which this does. The V code alone will not suffice in many instances. I suggest using the 33 modifier to prevent a denial. Or use the G code for screening colonoscopy.

 

[kmordway]

Agree with Debra. You still need the 33 modifier, which is to show it was a preventative service so it will not process with Pt OOP of copay or deductible. If you look at the Healthcare Reform Preventive Service Grid, 45378 is listed, showing you can use the 33 modifier.