Wiki Screening Colonoscopies for BCBS

[sscott@hogonc.com]

Can anyone tell me if BCBS is now accepting the screening G codes? I billed a screening colonoscopy with Z12.11 and 45378, and they did not cover the cost as a screening. They told the patient that it needs to be billed as a screening for them to waive the copay.

Thank you in advance!

 

[SBurns83]

Modifier Needed

For commercial insurance, you'll need a 33 modifier to show that the colonoscopy was done as a preventive screening.

 

[CodingKing]

Yep modifier 33 is the issue. I found the following from Blue Cross Massachusetts for example

https://provider.bluecrossma.com/Pr...8590e11ea/Gastroenterology_payment_policy.pdf

If a screening colonoscopy is performed with no findings,Submit the claim with CPT code 45378 or HCPCS code G0105/G0121, diagnosis code Z12.11, and modifier33 or PT

 

[ENDOCODER]

BCBS of Michigan has paid for the G Code for years w/ Z12.11 dx
If they find polyp or take biopsy/biopsies we use 33 Modifier. There are some groups now that we use the PT Modifier so BX knows this is their first one whether its routine or diagnostic and BX pays 100%

 

[sscott@hogonc.com]

Thank you for the information! A colleague told me that it depends on the insureds age. She said if the patient is over 50, you use the G codes. I had not heard that before.

 

[DFUGET]

You can bill G0121 with Z12.11 if the patient is at least 50 and there are no findings. If they are under 50 you need to bill 45378 with the Z12.11.