Wiki G0105 vs 45378

[Telcontar82]

A patient came in with a personal history of polyps and had a colonoscopy but nothing was found. I billed a G0105 V12.72 for the procedure and the facility billed a 45378 with V12.72. Mine got paid at 100% but the facility's was processed towards deduct. Now the facility is saying that the 45378 should be billed for every insurance but Medicare. Does anyone know what the correct way to do this is? Also, the patient's insurance is Healthnet of AZ.

 

[coachlang3]

Depends on the contract with the payor and if they accept the G codes. Technically the HCPCS are for Medicare use.

Any idea if the facility used the 33 modifier to denote that it was a screening?

 

[Telcontar82]

No I don't know if the facility used -33 modifier. I would think not because their claim went towards deductible where ours was paid 100% as preventative.

 

[EricaR]

As long as your patient is over 50, I feel you were completly accurate in your coding. It is all going to depend on the payer if they accept the G codes or not. I bill them ALL the time to private payers but I did research first to be sure they were recognized by that payer.