Wiki screening colonscopy

[cherylann.knighton]

hi!
Help!!
We have been getting a lot of patients complaining that their screening colonoscopies are being charged a deductible, when they should be covered at 100%. My question is - for Commercial Plans, we use the 45378 with the Z12.11 diagnosis. My interpretation is the Z12.11 shows that it was a screening. I'm not sure but should we be using the G- codes that Medicare requires for screening colonoscopies?
Thanks for your help!!
Cheryl

 

[cgaston]

We also thought the Z12.11 would be enough and ran into the same problem. We called all of our local carriers and were told to add the -33 modifer for diagnostic or -PT modifier if biopsy is performed. One carrier wants -33 on everything (diagnostic or not)!

So I suggest you call the insurance companies to find out their guidelines.

 

[cherylann.knighton]

screening colonoscopy

hi!
So we found out today that 4 of our payers in (Maine) support the G-codes for screenings.
Cigna
Anthem
Aetna
Harvard Pilgrim

Interesting....

 

[aprillerowland]

Commercial insurances use mod 33. However, our Georgia State Medicaid does not recognize the modifier so you would only use screening dx. You may want to check for your state as well. I hope this helps.