FUTURE09
Contributor
Hello,
I'm a seasoned CPT coder for over 28 years but just took a Billing Manager position at a GI practice in July 2018. I have spent many hours reading as many resources as I can get my hands on in regard to our high risk patients and when can I bill for a G0105.
Patient come in for a preventative screening and polyps are found and removed. I bill the appropriate CPT 40000 series and add my PT/33 modifier, using the Z12.11 diagnosis followed by the polyp diagnosis. Physician notes to schedule a surveillance screening in 3-5 years, accordingly to the CRC frequency. Patient comes in for surveillance (indication for surveillance screening) and we find no polyps. I then bill out the appropriate CPT 40000 series with DX Z09 and HX of polyps Z86.010. Physician then states again surveillance in 3-5 years.
This is where my confusion is coming in. When the high risk patient comes back and again there are no polyps can I bill the G0105 with DX Z12.11, Z86.010? Or does a high risk patient with hx of polyps never get assigned the G0105? My thought process is, we are trying to report that clean preventative screening on a patient that had polyps but now is clean.
I am out of resources and find myself in a state of frustration. I would so appreciate any advisement or directive.
Sincerely,
Kim Kovach, CPC
I'm a seasoned CPT coder for over 28 years but just took a Billing Manager position at a GI practice in July 2018. I have spent many hours reading as many resources as I can get my hands on in regard to our high risk patients and when can I bill for a G0105.
Patient come in for a preventative screening and polyps are found and removed. I bill the appropriate CPT 40000 series and add my PT/33 modifier, using the Z12.11 diagnosis followed by the polyp diagnosis. Physician notes to schedule a surveillance screening in 3-5 years, accordingly to the CRC frequency. Patient comes in for surveillance (indication for surveillance screening) and we find no polyps. I then bill out the appropriate CPT 40000 series with DX Z09 and HX of polyps Z86.010. Physician then states again surveillance in 3-5 years.
This is where my confusion is coming in. When the high risk patient comes back and again there are no polyps can I bill the G0105 with DX Z12.11, Z86.010? Or does a high risk patient with hx of polyps never get assigned the G0105? My thought process is, we are trying to report that clean preventative screening on a patient that had polyps but now is clean.
I am out of resources and find myself in a state of frustration. I would so appreciate any advisement or directive.
Sincerely,
Kim Kovach, CPC