Procedure code: 45380 ( Colonoscopy with biopsy) Will await pathology and consider surgical referral. Procedure: Colonoscopy with biopsy of rectal polyp. Post-endoscopy findings: Large sessile polyp in the rectum, unable to resect, pending pathology Indication: Personal history of colon polyps Colon screening Some Medicare payors instruct to only use the finding since the PT modifier indicates it was done for screening.Ģ11.3 ( Benign neoplasm, colon ) Modifier PT ( if Medicare patient) or Modifier 33 ( if non-Medicare) should be added to indicate this was a preventive service and to trigger benefitsĭiagnosis code: V76.51 ( Special screening for malignant neoplasms, colon). Procedure code: 45385 ( Colonoscopy with removal of polyp by snare) Procedure: Colonoscopy with removal of cecal and sigmoid polyps by snare technique Post-endoscopy findings: Polyps in the cecum and sigmoid colon Procedure code: G0105 ( High risk screening) or 45378-33 ( Diagnostic colonoscopy with modifier 33 indicating this is a preventive service)ĭiagnosis code: V12.72 ( Personal history of colon polyps) Post-endoscopy findings: Normal colonoscopy Indication: Personal history of colon polyps, Colon screening Procedure code: G0121 ( Average risk screening) or 45378-33 ( Diagnostic colonoscopy with modifier 33 indicating this is a preventive service).ĭiagnosis code: V76.51 ( Special screening for malignant neoplasms, colon) Post-endoscopy finding: Normal colonic mucosa Claims should be coded the same for procedures, modifiers and diagnosis with the exception of the discontinued procedure modifier (when the physician uses modifier 53, the outpatient hospital/ambulatory surgical facility uses modifier 74). Here are some examples for screening colonoscopy, which applies to both the physician and outpatient facility. HRPATIC FLEXTURE ICD 10 CODETo report screening on a Medicare beneficiary at high risk for colorectal cancer, use HCPCS G0105 and the appropriate diagnosis code that necessitates the more frequent screening. To report screening colonoscopy on a patient not considered high risk for colorectal cancer, use HCPCS code G0121 and diagnosis code V76.51 ( Special screening for malignant neoplasm of the colon). Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis. Medicare considers an individual at high risk for developing colorectal cancer as one who has one or more of the following:Ī close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp.Ī family history of familial adenomatous polyposis.Ī family history of hereditary nonpolyposis colorectal cancer.Ī personal history of adenomatous polyps. Beneficiaries at high risk for developing colorectal cancer are eligible once every 24 months. Medicare beneficiaries without high risk factors are eligible for screening colonoscopy every 10 years.
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