Wiki Help with Screening colonoscopy for Medicare under new LCD updates

[mconsuegra]

I have tried billing hcps code G0121 with modifier PT under DX code Z12.11 as primary, DX K57.30 as secondary and K64.1 as tertiary code. I have received denials from medicare stating "The procedure code is inconsistent with the modifier used or a required modifier is missing. We have attempted several different ways to re-code under medicare LCD updated with no results. Can anyone help or does anyone know of the new changes with medicare and how to bill properly under their new rules.

 

[clarkmegan]

I have tried billing hcps code G0121 with modifier PT under DX code Z12.11 as primary, DX K57.30 as secondary and K64.1 as tertiary code. I have received denials from medicare stating "The procedure code is inconsistent with the modifier used or a required modifier is missing. We have attempted several different ways to re-code under medicare LCD updated with no results. Can anyone help or does anyone know of the new changes with medicare and how to bill properly under their new rules.

If you are billing G0121, PT modifier is not necessary because the HCPCS code G0121 already implies screening in its description. You would use the PT modifier when a polyp is found to show that the original procedure was a screening, but turned diagnostic to remove the polyp. For example, the coding for polyp removal by hot snare would look like this: 45385-PT. Based on your example, you should be paid with the G0121-Z12.11. Check to make sure the patient has not already used their preventive benefits.