Forum - Questions & Answers

Oct 27th, 2016 - DOCLV1982

Colonoscopy

Hello, when billing a 45380 & 45385or 45378, when its a Medicare pt and screening code was given, but also polyp and diverticulosis was found, would you use the G0121 or G0105 with the screening as the primary dx or one of the CPT® codes with the medical dx codes? Also how would you need to bill it say if the insurance was Anthem or Med Mut

Oct 27th, 2016 - rphelps 615  1 

re: COLONOSCOPY

First of all bill all insurances the same. If per qualifies for screening not high risk use G0121. If high risk and you are doing a 2 year screening use G0105. Do not mix symptons or medical dx with screening codes.

Oct 27th, 2016 - rphelps 615  1 

re: COLONOSCOPY

Sorry I didn't read it well. If you start out as a screening and polyps are foung use the 45380 or 45385 with the screening dx (Z12.11 or whatever and the k63.5 polyp code second.

Oct 31st, 2016 - OAMLIPT 1 

re: COLONOSCOPY

Also Medicare requires the PT Modifier to indicate the procedure was initially a screening colonoscopy but a polyp was removed or biopsies were taken. Medicare will waive the deductible. Commercial insurance use 33 Modifier. Most important is the screening diagnosis code first and then the polyp code 2nd



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