milema2
Contributor
Hi All,
We are in need of your professional opinions, When Billing for a “High Risk” screening colonoscopy, How do you let the Insurance Company know this is a “screening”?
What do you think about modifier 33 for Commercial payers? Medicare we can use G0105 or the PT Modifier.
Or will they ever be a “screening colonoscopy”?
Below per 2016 CPT Cod1ng updates Gastroenterology CPT Advisors
X Billing for a screening colonoscopy in an average-risk patient: • G0121 (Medicare) or 45378 (Medicaid, commercial, exchange, Tricare) with the appropriate ICD-10 code for screening: n Z12.11 — encounter for screening for malignant neoplasm of colon. n Z12.12 — encounter for screening for malignant neoplasm of rectum. X Billing for screening colonoscopy in a high-risk patient: • G0105 (Medicare) or 45378 (Medicaid, commercial, exchange, Tricare) with the appropriate ICD-10 code for screening: n K50 — Crohn’s disease. n K51 — ulcerative colitis. n K52.1 — toxic gastroenteritis and colitis. n K52.89 — other specified noninfective gastroenteritis and colitis. n K52.9 — noninfective gastroenteritis and colitis, unspecified. n Z85.038 — personal history of other malignant lesion of large intestine. n Z85.048 — personal history of other malignant lesion of rectum, rectosigmoid junction and anus. n D12.6 — benign neoplasm of colon, unspecified. n Z15.09 — genetic susceptibility of other malignant neoplasm. n Z80.0 — family history of malignant neoplasm of digestive organs. n Z83.71 — family history of colonic polyps. n Z86.010 — personal history of benign neoplasm of colon.
Thank you in advance.
We are in need of your professional opinions, When Billing for a “High Risk” screening colonoscopy, How do you let the Insurance Company know this is a “screening”?
What do you think about modifier 33 for Commercial payers? Medicare we can use G0105 or the PT Modifier.
Or will they ever be a “screening colonoscopy”?
Below per 2016 CPT Cod1ng updates Gastroenterology CPT Advisors
X Billing for a screening colonoscopy in an average-risk patient: • G0121 (Medicare) or 45378 (Medicaid, commercial, exchange, Tricare) with the appropriate ICD-10 code for screening: n Z12.11 — encounter for screening for malignant neoplasm of colon. n Z12.12 — encounter for screening for malignant neoplasm of rectum. X Billing for screening colonoscopy in a high-risk patient: • G0105 (Medicare) or 45378 (Medicaid, commercial, exchange, Tricare) with the appropriate ICD-10 code for screening: n K50 — Crohn’s disease. n K51 — ulcerative colitis. n K52.1 — toxic gastroenteritis and colitis. n K52.89 — other specified noninfective gastroenteritis and colitis. n K52.9 — noninfective gastroenteritis and colitis, unspecified. n Z85.038 — personal history of other malignant lesion of large intestine. n Z85.048 — personal history of other malignant lesion of rectum, rectosigmoid junction and anus. n D12.6 — benign neoplasm of colon, unspecified. n Z15.09 — genetic susceptibility of other malignant neoplasm. n Z80.0 — family history of malignant neoplasm of digestive organs. n Z83.71 — family history of colonic polyps. n Z86.010 — personal history of benign neoplasm of colon.
Thank you in advance.