Friday, February 12, 2016

CPT CODE 45378 and 45385 and Covered DX

Screening colonoscopy for a low risk patient with no findings during the colonoscopy

Procedure Diagnosis

The colonoscopy procedure code:

o 45378 with modifier 33 indicating that the service was preventive
OR
o G0121

The screening diagnosis code:

o V76.51

Screening colonoscopy during which a polyp in the large intestine is found, removed with a snare and sent to pathology

The colonoscopy procedure code:

o 45385 with modifier 33 indicating that the service was preventive

 The screening diagnosis code:

o V76.51 AND The diagnosis code for the condition found: o 211.3


Diagnostic colonoscopy performed due to signs or symptoms, or to ruleout or confirm a suspected diagnosis

Procedure Diagnosis

The colonoscopy procedure code:

o 45378 WITHOUT modifier 33

o DO NOT use the G screening codes listed above

If a specific condition is NOT confirmed, then submit the diagnosis code for the sign(s) or symptom(s).

If a specific condition IS confirmed, then submit the diagnosis code for the confirmed condition.

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