We are having a issue with insurances not paying for a screening colonoscopy benefits when we are billing with the diagnosis code Z12.11 but when doing the procedure they remove a polyp. So we bill with diagnosis code Z12.11 as the primary and the procedure code is 45380 with modifier PT to state it started as a screening.
Patients have benefits of 100% for a screening but they don't pay that when we bill this way. I was always told that once the polyp is removed it is no longer a screening and benefits won't be covered as a screening but now we are having discussion in our office that the insurance should still pay the screening benefits since that is the reason the pt came into the office.
Any help is greatly appreciated.
Thanks
Dawn
Patients have benefits of 100% for a screening but they don't pay that when we bill this way. I was always told that once the polyp is removed it is no longer a screening and benefits won't be covered as a screening but now we are having discussion in our office that the insurance should still pay the screening benefits since that is the reason the pt came into the office.
Any help is greatly appreciated.
Thanks
Dawn