This was on the Americal Gastroenterology Association web site. This seems to be totally different then the way things were explained in Coding edge. All along I have been taught once a person has polyps or CA that no longer is the procedure considered screen/preventative and that you do not use mod 33 and that if no bx was taken and it was a screen you did not need to put a 33 on the 45378. Now I am totally confused. Any input would be greatly appreciated! The only one of these I would have coded the same would have been #5.
Example #1
Indication: Colon screening
Post-endoscopy finding: Normal colonic mucosa
Procedure code: G0121 (Average risk screening) or 45378-33 (Diagnostic colonoscopy with modifier 33 indicating this is a preventive service).
Diagnosis code: V76.51 (Special screening for malignant neoplasms, colon)
Example #2
Indication: Personal history of colon polyps, Colon screening
Post-endoscopy findings: Normal colonoscopy
Procedure code: G0105 (High risk screening) or 45378-33 (Diagnostic colonoscopy with modifier 33 indicating this is a preventive service)
Diagnosis code: V12.72 (Personal history of colon polyps)
Example #3
Indication: Colon screening
Post-endoscopy findings: Polyps in the cecum and sigmoid colon
Procedure: Colonoscopy with removal of cecal and sigmoid polyps by snare technique
Procedure code: 45385 (Colonoscopy with removal of polyp by snare)
Modifier PT (if Medicare patient) or Modifier 33 (if non-Medicare) should be added to indicate this was a preventive service and to trigger benefits
Diagnosis code: V76.51 (Special screening for malignant neoplasms, colon). Some Medicare payors instruct to only use the finding since the PT modifier indicates it was done for screening.
211.3 (Benign neoplasm, colon [based on pathology report])
Example #4
Indication: Personal history of colon polyps; Colon screening
Post-endoscopy findings: Large sessile polyp in the rectum, unable to resect, pending pathology
Procedure: Colonoscopy with biopsy of rectal polyp. Will await pathology and consider surgical referral.
Procedure code: 45380 (Colonoscopy with biopsy)
Modifier PT (if Medicare) or Modifier 33 (non-Medicare) should be added to indicate this was a preventive service and to trigger preventive
Diagnosis code: V12.72 (Personal history of colon polyps). Some Medicare payors [First Coast and Noridian] instruct to only use the finding since the PT modifier indicates it was done for screening.
211.4 (Benign neoplasm, rectum) or 235.2 (Neoplasm uncertain behavior, intestines and rectum [based on pathology report]).
Example #5
Indication: Change in bowel habits, here for colon screening
Post-endoscopy findings: Normal colon
Procedure: Colonoscopy
Procedure code: 45378
Do not append modifier 33 or PT, as this service was performed for a diagnostic, not screening, indication.
Example #1
Indication: Colon screening
Post-endoscopy finding: Normal colonic mucosa
Procedure code: G0121 (Average risk screening) or 45378-33 (Diagnostic colonoscopy with modifier 33 indicating this is a preventive service).
Diagnosis code: V76.51 (Special screening for malignant neoplasms, colon)
Example #2
Indication: Personal history of colon polyps, Colon screening
Post-endoscopy findings: Normal colonoscopy
Procedure code: G0105 (High risk screening) or 45378-33 (Diagnostic colonoscopy with modifier 33 indicating this is a preventive service)
Diagnosis code: V12.72 (Personal history of colon polyps)
Example #3
Indication: Colon screening
Post-endoscopy findings: Polyps in the cecum and sigmoid colon
Procedure: Colonoscopy with removal of cecal and sigmoid polyps by snare technique
Procedure code: 45385 (Colonoscopy with removal of polyp by snare)
Modifier PT (if Medicare patient) or Modifier 33 (if non-Medicare) should be added to indicate this was a preventive service and to trigger benefits
Diagnosis code: V76.51 (Special screening for malignant neoplasms, colon). Some Medicare payors instruct to only use the finding since the PT modifier indicates it was done for screening.
211.3 (Benign neoplasm, colon [based on pathology report])
Example #4
Indication: Personal history of colon polyps; Colon screening
Post-endoscopy findings: Large sessile polyp in the rectum, unable to resect, pending pathology
Procedure: Colonoscopy with biopsy of rectal polyp. Will await pathology and consider surgical referral.
Procedure code: 45380 (Colonoscopy with biopsy)
Modifier PT (if Medicare) or Modifier 33 (non-Medicare) should be added to indicate this was a preventive service and to trigger preventive
Diagnosis code: V12.72 (Personal history of colon polyps). Some Medicare payors [First Coast and Noridian] instruct to only use the finding since the PT modifier indicates it was done for screening.
211.4 (Benign neoplasm, rectum) or 235.2 (Neoplasm uncertain behavior, intestines and rectum [based on pathology report]).
Example #5
Indication: Change in bowel habits, here for colon screening
Post-endoscopy findings: Normal colon
Procedure: Colonoscopy
Procedure code: 45378
Do not append modifier 33 or PT, as this service was performed for a diagnostic, not screening, indication.