I am trying to find out why I can not bill 45380-PT dx z12.11 for Medicare patients. We have patients that are scheduled for screenings but during the procedures biopsies are done. We are now being told it can no longer be a screening but has to be a diagnostic only. By adding the PT modifier it should qualify. Has anyone else run into this issue and if so what do you do?
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Wiki Medicare diagnostic colonoscopy with biopsy
- Thread starter kheeseman77@gmail.com
- Start date
lamiller
Contributor
When billing for Medicare and it's a screening turned into diagnostic I will usually code it with DX finding (EX cecum benign adenoma, D12.0) followed by Z12.11. CPT would either by 45385 for snare biopsy or 45380 for cold forceps with the PT modifier. I hope this helps.