How do I bill for surveillance colonoscopy?
What’s the right code to use for screening colonoscopy? For commercial and Medicaid patients, use CPT code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression [separate procedure]).
What modifier should be used for screening of colonoscopy?
2) Append the –PT modifier to the CPT® code. The –PT modifier indicates a screening colonoscopy has been converted to a diagnostic test or other procedure.
When is it appropriate to use modifier 33?
If you provide multiple preventive medical services to the same non-Medicare patient on the same day, append modifier 33 to the codes describing each preventive service rendered on that day. You may also apply modifier 33 when a preventive service must be converted to a therapeutic service.
Do you use Z12 11 on surveillance colonoscopy?
There are 2 different sets of screening colonoscopy codes:
There are payors that accept the Z12. 11 (encounter for screening for malignant neoplasm of colon) in the first coding position, while other payors either require this diagnosis in a subsequent position behind family history codes or prefer to see the Z12.
What is the difference between a screening colonoscopy and a surveillance colonoscopy?
Medicare and most insurance carriers will pay for screening colonoscopies once every 10 years. Surveillance colonoscopies are performed on patients who have a prior personal history of colon polyps or colon cancer. Medicare will pay for these exams once every 24 months.
Is surveillance colonoscopy the same as a diagnostic colonoscopy?
Diagnostic colonoscopy procedures, also known as surveillance or follow-up colonoscopy tests, are different from screening colonoscopies, tests are only advised when there is a greater risk that colon cancer might develop or if there is evidence that colon cancer may be present.
Is a surveillance colonoscopy considered preventive care?
A colonoscopy is an important preventive care screening test that helps detect pre-cancer or colon cancer. The earlier signs of colon cancer are detected, the easier it is to prevent or treat the disease.
What does CPT modifier 33 mean?
Modifier 33 is a CPT modifier used to identify medical care whose primary purpose is delivery of an evidence based service, based on recommendations from the US Preventive Services Task Force. Use when the USPSTF has given the service an A or B rating.
What is the difference between modifier 33 and PT?
Modifier 33 is a valid CPT modifier and may be used for all payers. Check with individual payers for their instructions. Modifier PT is more specialized and will be used by fewer practices. It is a HCPCS modifier, used to indicate that a colorectal screening service converted to a diagnostic or therapeutic service.
What is the ICD 10 code for surveillance colonoscopy?
A screening colonoscopy should be reported with the following International Classification of Diseases, 10th edition (ICD-10) codes: Z12. 11: Encounter for screening for malignant neoplasm of the colon.
What’s a surveillance colonoscopy?
Surveillance colonoscopy is any colonoscopic examination performed to identify recurrent or metachronous neoplasia in an asymptomatic individual with previously identified precan- cerous lesions (the term surveillance is also applied to patients with previous cancer but that group is not covered here).
What does surveillance colonoscopy mean?
Surveillance refers to the process of evaluating patients with a personal history of polyps or cancer. People who have precancerous polyps completely removed should have a colonoscopy every 3-5 years, depending on the size and number of polyps found.
Does Medicare pay for modifier 33?
Medicare payors do not recognize modifier 33, and will not reimburse claims submitted with the modifier. Medicare requires the use of dedicated G codes to describe covered preventive services (e.g., G0202 Screening mammography, producing direct digital image, bilateral, all views).
What is the difference between screening and surveillance colonoscopy?
What does modifier 33 represent?
Modifier 33: preventive service.
Modifier 33 is applied to indicate that the preventive service is one that waives a patient’s co-pay, deductible, and co-insurance. An exception is that modifier 33 does not have to be appended to those services that are inherently preventive (for instance, screening mammography).
Is a surveillance colonoscopy the same as a screening?
Diagnostic colonoscopies, also known as follow-up or surveillance colonoscopies, are different from screening colonoscopies, as they are performed when there is a greater chance that cancer might develop or in the event there are indications that colon or rectal cancer may exist.
What is the ICD-10 code for surveillance colonoscopy?
Is surveillance colonoscopy considered diagnostic?