Wiki Colon Screening

[mir25_2000]

Here's my scenario:

The patient presented for colonscopy screening but has a history of colon polyps. We intended it to be screening but he was found to have another polyp that was removed by hot biopsy. Am I wrong to bill with 45384-33 and V76.51, 211.3, V12.72?

Thanks for your help.

 

[MAult142]

45384 is the correct CPT code. If the patient has commercial insurance then 33 is the correct modifier. If the patient has Medicare or medicare replacement you should use PT instead. But if the patient has hx of polyps then the primary dx code would be V12.72 and 211.3 would be your secondary code. Unless this was the patient's first colonoscopy and since they already have a hx of polyps that seems unlikely, V76.51 shouldn't be on the claim.

The good news is Medicare and medicare replacement consider personal hx to be preventative. The bad news is commercial usually does not.

 

[mir25_2000]

Thank you so much.