Learn about Colonoscopy and Endoscopy billing procedure methodologies. GI gastrointestinal endoscopy and colonoscopy preparation, complication and what happened after the process. How to do the correct billing. EGD, GI and Screening CPT codes.
Friday, May 6, 2016
Billing for Screening Colonoscopy or Sigmoidoscopy
The AMA created modifier 33 to allow providers to identify a preventive service for which, under the PPACA, there is no patient cost sharing. Use modifier 33 with a CPT code for a diagnostic/treatment service performed as a preventive service, such as a screening colonoscopy, even if a polyp is found and removed.
You may also use G codes intended for use for screening procedures for colorectal cancer screening:
o G0105: colonoscopy screening for individuals at high risk
o G0121: colonoscopy screening for individuals who are not high risk
o G0104: flexible sigmoidoscopy screening
When billing for preventive screening colonoscopy or sigmoidoscopy for any BCBSMA member, use modifier 33 or one of the G codes above so that the claim pays without any member cost share, according to the member’s benefits.
Do not use modifier 33 to bill for individuals receiving procedures due to signs or symptoms, or to rule out or confirm a suspected diagnosis. In this case, the procedure would be considered a diagnostic exam, not a screening exam. See the table on page 1 for coding examples. As always, be sure to check eligibility and benefits to determine appropriate member cost-sharing
National Guidelines
National guidelines recommend colorectal cancer screening starting at age 50 then every 10
years. However, more frequent or earlier screening is recommended for patients with certain
increased risk factors, such as a family history of colon cancer or personal history of polyps.
Screening in these situations will now also be covered when billed as a preventive service.**
Subscribe to:
Post Comments (Atom)
Most read colonoscopy CPT codes
-
CPT CODE 49082 - Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance -Average fee amount $200 CPT CODE 49083 - ...
-
EGD - Procedure Most used CPT code list and description 43235 EGD diagnostic Fee schedule amount $ 310.8 43239 EG...
-
CPT Code Description 47562 Laparoscopy, surgical; cholecystectomy - Average fee amount - $600 - $750 47563 - Laparoscopy, surgical; c...
-
Colonoscopy Billing tips - cpt 45380 45385 As a speaker at many national conferences, I find the question most frequently asked is, ...
-
Skip 46930 with Revised Hemorrhoidectomy Codes Make sure you’re not reporting destruction of internal hemorrhoids by thermal energy with ...
-
EGD CPT CODES COVERED ICD-10 Codes that Support Medical Necessity B25.2 Cytomegaloviral pancreatitis B37.81 Candidal esophagitis C15.3...
-
Flexible Sigmoidoscopy Specific instructions for reporting flexible sigmoidoscopy have been added to the section guidelines. Report flexib...
-
Argon Plasma Coagulation Argon plasma coagulation: A non-contact thermal technique which uses ionized argon gas to deliver a high-frequenc...
-
97010 - Application of a modality to 1 or more areas; hot or cold packs Average fee amount $5 -$10 97012 - Application of a modality to 1 ...
-
Diagnostic and Therapeutic Esophagogastroduodenoscopy CPT/HCPCS Codes 43233 Egd balloon dil esoph30 mm/> 43235 Egd diagnostic br...

No comments:
Post a Comment