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#1
07-25-2012, 02:41 PM
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colon screen
I need some opinions on how to bill this we have sent it in to medicare several times trying different things and we keep getting denied however the facility has gotten paid ( I have billed the exact same as they did codes and diagnosis and in same order) which we were told by medicare that it pays differently to facility.
Patient had a colon done with bx indication is screening in patient at increased risk: Colorectal cancer in brother before age 60. Biopsy with cold forceps was done for diagnostic purposes . Pathology came back showing only proctitis ( which is not an approve diagnosis for medicare to pay for) I have billed 45380-pt, v16.0 and v76.51 denied, 45380, v16.0 and v76.51 denied on both claims a not was attached with who had the colon cancer. Do I need to just bill with the v76.51 and not the v16.0? Do I use the PT modifer? Thanks for any help anyone can provide!! 
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#2
07-25-2012, 03:33 PM
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I would do the 45380-PT, V76.51, 569.49, V16.0 and change the dx pointers on your claim to 2,1,3.
Anytime I have a screening turned dx for Medicare they are telling me to list the codes, screening (v76.51) and then the reason for the diagnostic (path) and then change the pointers to the opposite.
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#4
07-26-2012, 06:21 AM
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Pam's got the right suggestion.
Generally, when it comes to Medicare the PT modifier takes the place of the V76.51. They also accept the personal or family history codes in the first dx spot.
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