Wiki which V code should be primary?

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larmendarez

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For Cigna and Aetna plans, they have been paying my claims with V12.72 and 45380 as diagnostic ( even though I add the modifier 33). So my question is - if a patient has family history colon cancer V16.0, and personal history polyps V12.72; is it appropriate to code the V16.0 as primary dx, V12.72 as secondary dx, then the 211.3 with CPT 45380 and add the modifier 33? (Cigna and Aetna will pay the V16.0 with modifier 33 on proceudre code as a screening benefit.):D
 
In my opinion the patient's own history should come before family history. Ultimately you need to go by the documentation. What is the reason for the colonoscopy - personal hx or family hx? If it is both then I would code personal hx first. Hope this helps!
 
I know of no expert documentation that states one way or another. However, like the previous post, my opinion is that a personal hx trumps family hx. I also agree that the reason for the colonoscopy needs to be considered.
 
ibtrazy said:
Bridgette,
Why would mod 33 be used on this one if it wasn't a "screening"?
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Modifier -33 signifies a service was a preventative service. They are without current signs and symptoms of a problem. There is not crystal clear direction as to the application of this modifier for surveillance colonoscopies being appropriate or not.
I have commented on this extensively in another post, that I can't immediately put my hands on.
Medicare allows a "screening" colon for a high risk person every 2 years. Modifier -PT is appended when a high risk screening colon converts to a therapuetic colon. After extensive research, we decided to append modifier -33 to preventative colonoscopies for commercial payers. It is up to the payer policy to determine if the patient has a cost-share, as many plans have been grandfathered in and are not required to follow the heath care mandate.
 
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