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.

Full Article

Latest posts by admin aapc (see all)

Read the complete Article

Login as a member or sign up for free to get uninterrupted access to AAPC blog posts and stay updated on industry news through our monthly newsletter.


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”.

Leave a Reply

Your email address will not be published. Required fields are marked *