Wiki Colonoscopies - The Cutting Edge had a good

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kathy a

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The Cutting Edge had a good article in its March issue regarding colonoscopies. It now states that colonoscopies are divided into 3 categories-Diagnostic, Preventative, and Surveillance. Which is great and makes sense.If the patient is having problems-it is Diagnostic. If patient is over 50 and asymptomatic it is a Screening. If patient has had a colonoscopy in the past and had polyps or diverticulosis it is now considered Surveillance.
I am OK with that. I know we can charge for a new or established office visit with diagnostic-since there is a problem. I also know that if patient comes in for a screening and is asymptomatic we cannot charge for the office visit as it is included in the cost of the surgery. My question is in regards to the Surveillance Colonoscopy. Can we bill for the office visit prior to the colonoscopy due to the fact that they had polyps, diverticulosis,etc?
With the Surveillance colonoscopy in a Medicare patient-if a colonoscopy with biopsy is performed would you use the 45380 code instead of the G0105 code-since a biopsy was performed? Would any modifiers be used-such as PT? Or is the PT modifier only to be used on a screening colonoscopy?
Can someone further clarify the whole colonoscopy thing to me. I just want to make sure that I am coding these correctly.
 
Hi Kathy,

You would code the 45380 instead of G0105 if a biopsy is performed, and for medicare patients you would use the modifer PT in that situation. The following link from the AGA is helpful: http://www.gastro.org/journals-publ...l-practice/cms-issues-guidance-on-pt-modifier.

Also in regards to the office visit, we do not bill these visits for pts that have had polyps or divertic. in the past; what would the cc be? Also if the patient is coming in because they know they need a scope; where is the MDM? I'm not the best at explaining why the E/M is not billable but I know we never bill it. :)

Erica
 
In the example you gave, I would say you should bill 45380 WITHOUT the modifier PT. The article says that a surviellance colonoscopy is not a screening and the definition of the PT modifier is for a screening converted to a procedure.
 
I would be suspect of billing the E/M to an established patient on the same day.
What would rise to the level of separately identifiable in that case?
The ROS wouldn't, the exam wouldn't.
What's left?
 
"CMS issued an MLN Matters article, which provides guidance on the extension of waiver of deductible to services furnished in connection with or in relation to a colorectal screening test that becomes diagnostic or therapeutic.

Effective Jan. 1, 2011, the Affordable Care Act waives the Part B deductible for colorectal cancer (CRC) screening tests (codes G0104, G0105, G0106 and G0121) that become diagnostic. The AGA advocated heavily for this change and is pleased that CMS is implementing this waiver in all three outpatient settings — physician, hospital outpatient department and ambulatory surgery center.

Providers should append modifier PT (CRC screening test converted to diagnostic test or other procedure) to the diagnostic procedure code that is reported when the screening colonoscopy or flexible sigmoidoscopy becomes a diagnostic service. The claims processing system will respond to the modifier by waiving the deductible for all surgical services on the same date as the diagnostic test" -AGA

Medicare does NOT differentiate screening or surviellance colonoscopy. They view a G0105 as a "screening" colonoscopy.
 
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