Forum - Questions & Answers

Aug 5th, 2011 - Shannan 28 

Screening Colonoscopies/diagnostic

We had a pt come in for a screening colonoscopy 45378 dx v76.51, the doc found polyps and had to send them for biopsy so would I also use CPT® code 45380 or 45385 with a dx of 211.3 and would I use a modifier PT or 59. Please help!!! Thank You

0 Votes - Sign in to vote or reply.
Aug 5th, 2011 - koatsj 160 

re: Screening Colonoscopies/diagnostic

First off, if the doctor snared the polyp you would use 45385. If he just biopsied the polyp, you would use 45380. I would wait for the pathology results before I billed it to make sure it is a polyp and whether or not it is benign or malignant. If it is benign, you are right with 211.3. Then, you would use PT if the patient is Medicare to show it started off as a screening and then turned diagnostic.

0 Votes - Sign in to vote or reply.
Aug 5th, 2011 - Shannan 28 

re: Screening Colonoscopies/diagnostic

I do have the results back and it is a 211.3, the pt has Blue Cross insurance, so should I use a different modifier?

0 Votes - Sign in to vote or reply.
Aug 5th, 2011 - koatsj 160 

re: Screening Colonoscopies/diagnostic

You don't have to use a modifier at all then. Just bill 211.3 with your CPT® code.

0 Votes - Sign in to vote or reply.
Aug 5th, 2011 - Shannan 28 

re: Screening Colonoscopies/diagnostic

So do I use the 45378 for the diagnostic in conjunction to the 45385? It started out as a diagnostic

0 Votes - Sign in to vote or reply.
Aug 5th, 2011 - koatsj 160 

re: Screening Colonoscopies/diagnostic

No, if the polyp was removed by snare ONLY use 45385. Make sure you bill it as V76.51 first and then 211.3 as well to show that it started off as a screening. Sorry not to have mentioned that before.

0 Votes - Sign in to vote or reply.
Aug 5th, 2011 - Shannan 28 

re: Screening Colonoscopies/diagnostic

Thank You so much for all of your help.. It is greatly appreciated.

0 Votes - Sign in to vote or reply.
Aug 5th, 2011 - koatsj 160 

re: Screening Colonoscopies/diagnostic

You are welcome.

0 Votes - Sign in to vote or reply.
Aug 5th, 2011 - j.berkshire 7 

re: Screening Colonoscopies/diagnostic

And I would suggest adding the 33 modifier to 45385 or 45380. This exam was screening, and the 33 preventive modifier is appropriate so cost shares are applied appropriately.

0 Votes - Sign in to vote or reply.


Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2021 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association