Wiki G0121 and g0105

[kim culp]

Should the physician bill bill screening codes even if he finds polyps or hemorroids?

And for commercial carriers should he use dx screening as primary even if he finds something?

 

[ginaCW]

based from my knowledge ...diagnostics are always bundled together...you cant bill for it.

 

[ginaCW]

i mean screening

 

[andreagail]

G0121 and G0105

These codes are used if paitent is seen for screening (lo risk and hi risk). If a polyp is found and hence removed, the procedure becomes diagnostic and is billed as such. No screening code is used at that point although you may use modifier PT to indicate that procedure was originally intended as a screening.

 

[tpontillo]

You wont use the G codes if removing a polyp. use the 45380 or the appropriate code. Use the PT modifier stating this was intended to be a screening but turned diagnostic. For the diagnosis you are using the V76.51 as primary and then the findings as secondary. The same goes for the commercial ins. Bill the appropriate cpt code and the screening dx is primary and the findings are secondary. For the commercial insurance you are using a 33 modifier

 

[DEDGE CGIC]

Be aware of which payers are accepting the pt (medicare) and 33 (commercial payers). we have found that currently only Anthem and some great west divisions are accepting the 33 modifier. Most other providers failed to update their systems at the beginning of the year causing the claims to deny due to an "invalid" modifier.
The pt modifier also has a very specific pattern of usage which our system currently is unable to perform. Hope this helps.