Wiki Colonoscopoy

[Bbp2154]

We do procedures here in the office I do the billing and I am endo tech, however, my question is for this one procedure we did this past week, dr wants to code G0105 for family history of colon cancer and 45378 for constipation. Now I have never coded a G code with a procedure code, Please tell me that I am correct that we cannot bill both. In addition, the patient had no biopsies. The colonoscopy was normal. So I would like to just bill the G0105 code which is the higher value .

Thank You for your help in advance
Barbara

 

[mitchellde]

you cannot code both together, and selection is not made based on the reimbursement but on the reason for the test. If this was performed for screening reasons, meaning the patient had no complaints then you use the V76.x code first then the family hx second and the G code for the test. If the patient had a symptom/complaint of constipation and that was the reason for the test then you cannot use the G code for the test you would code the problem with the family hx second and the CPT code for the diagnostic test.

 

[coachlang3]

Why was the patient seen? And why did the doctor do the procedure?

You cannot bill both.

If the doctor is wanting to charge a 45378 than the constipation was medically significant and there is no screening if the patient has symptoms.

 

[Bbp2154]

Colonoscopy

Thank you
I just read the note and patient did have symptoms of constipation, so 45378 is the correct code to bill, however I can add the second diagnoses of family history of colon cancer
V16.0
I do appreciate you help and thank you all once again
Barbara

 

[CBaez]

You cannot bill both

you cannot code both together, and selection is not made based on the reimbursement but on the reason for the test. If this was performed for screening reasons, meaning the patient had no complaints then you use the v76.x code first then the family hx second and the g code for the test. If the patient had a symptom/complaint of constipation and that was the reason for the test then you cannot use the g code for the test you would code the problem with the family hx second and the cpt code for the diagnostic test.

you cannot bill both

 

[mitchellde]

you cannot bill both

That is what I said, I stated you cannot bill both it is one or the other based on the reason for the test.
As far as can you add the family hx to the the constipation for the diagnostic study, yes of course you can as long as it is a secondary code, does it make a difference for the reimbursement? I cannot see that it would matter in the least for the reimbursement.