Today’s Surgicenter: “Colonoscopy Billing”

AAPC member Donna SanGiovanni discusses proper coding for a screening colonoscopy. In this article, she examines what qualifies as a screening colonoscopy, as well as specific rules for coding and billing polypectomies, Medicare screenings and incomplete colonoscopies.

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5 Responses to “Today’s Surgicenter: “Colonoscopy Billing””

  1. Suzanne Howell says:

    It is my understanding that if a polyp is removed you only code the method of removal, eg. 45385 and not the biopsy code 45380. If you biopsy a seperate site, then I would bill 45385 and 45380 with a 59 modifier. I would code V76.51 as primary and 211.1 as secondary and attached the secondary to the procedure(s) if the polyp was found to be benign.

    If a MCR colonoscopy was performed and not completed, I would append a modifier 53. For commercial, I would append a modifier 52, that is when filing for the physician.

  2. TERRY CPC says:

    If you are doing a colonoscopy I believe a polyp finding would be 211.3 or 211.4 I don’t think the doctor would go all the way to the stomach. 211.1 is benign neo of the stomach.

  3. Becky J., CPC says:

    I you’re billing for polyp removal, use 45385, dx 211.3 or 211.4, as Terry says. If colonoscopy was performed and not completed, I would append mod 53 to either MCR or commercial.

  4. Karen B CPC says:

    For polyp removal Becky and Terry are correct with 211.3 or 211.4. This could actually be a 235.2 depending on the path report. What happens during the procedure would determine if I would use a 52 for reduced services or a 53 for a discontinued procedure. This would be for either MCR or commercial insurance. I guess it all depends on interpretation. From the GI coding seminars I have attended, they state to use a 52 unless the patient’s well being is at stake.

  5. Carmen says:

    How about the anesthesia during a colonoscopy? Is Medicare still paying for the anesthesia?
    I know that Blue Cross will only pay if “Medically Necessary”.

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