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Wiki Screening colonoscopy w/v12.72
- Thread starter zita
- Start date
ChristineA
Networker
I would use V12.72. Just out of curiosity when was their last procedure done and have they changed insurance companies from a commercial insurance to Medicare?
We have a lot of patient's who want us to bill a colon screen because they say their insurance will only pay for a screen but their last colon showed adenomatous polyps but I bill the V12.72 if you have a hx of adenomatous polyps
We have a lot of patient's who want us to bill a colon screen because they say their insurance will only pay for a screen but their last colon showed adenomatous polyps but I bill the V12.72 if you have a hx of adenomatous polyps
syllingk
Guest
by the way, cms considers that a surveillence colonoscopy, not screening.
Colliemom
Expert
Once the patient has a history of adenomatous polyps, colorectal cancer or inflammatory bowel disease they would no longer have a "screening" colonoscopy.
Use the V12.72, and if it is a commercial payor use the -33 modifier. Use the -PT modifier if it is a Medicare plan.
Use the V12.72, and if it is a commercial payor use the -33 modifier. Use the -PT modifier if it is a Medicare plan.
ssmith955
Contributor
V12.72
So the jist is that V12.72 will always be considered a diagnostic procedure? If that is the case the the insurance companies reps who are selling the product should NEVER tell the employees that their package covers colonscopies even if they are at high rick due to hx of polyps v12.72. So in a way all our troubles with patients complaining is that they have been misled by their insurance broker and the HR department of their company
So the jist is that V12.72 will always be considered a diagnostic procedure? If that is the case the the insurance companies reps who are selling the product should NEVER tell the employees that their package covers colonscopies even if they are at high rick due to hx of polyps v12.72. So in a way all our troubles with patients complaining is that they have been misled by their insurance broker and the HR department of their company
ssmith955
Contributor
V12.72
Thank you all for your replies, this is like banging head against the wall. We tell the patients that the V76.51 can never be used again once a patient has a hx of polyps. We do use the 33 or PT modifier on the CPT. Thank you all again for the input
Thank you all for your replies, this is like banging head against the wall. We tell the patients that the V76.51 can never be used again once a patient has a hx of polyps. We do use the 33 or PT modifier on the CPT. Thank you all again for the input
syllingk
Guest
The scopes are usually covered but not under any preventative policies. You would not use a modifier because that is telling them it was preventative turned diagnostic.