Screening Colon

[Peke]

If a patient comes in for a screening colon dr.does cold forcep biopsy for something unrelated to polyps such as proctitis and proctitis is not a payable dx for colon? What would you bill?

 

[MelodyCPC]

Based on the details you provided, I would code cpt 45380-PT with dx 1) proctitis (569.49?) 2)V76.51.

 

[mitchellde]

Based on the details you provided, I would code cpt 45380-PT with dx 1) proctitis (569.49?) 2)V76.51.

When a pt presents for the screening V code is always the first listed dx code the findings if any ae listed secondary . Refer to the coding guidelines for this info

 

[swethathulasi]

Hi
As the patient comes for screening colonoscopy, dx V76.51 should be primary followed by dx Proctitis 569.49

Swetha.B.D, CPC

 

[MelodyCPC]

Hi
As the patient comes for screening colonoscopy, dx V76.51 should be primary followed by dx Proctitis 569.49

Swetha.B.D, CPC

I agree...V76.51 primary and 569.49 secondary. There is a Medlearn Matters publication (SE0746) that advises you to only link diagnosis 2 (the abnormal finding) to the procedure, but still show the V76.51 on the claim...our billing system doesn't allow us to do that...does anyone else have that problem?

 

[EricaR]

MelodyCPC,

We had that exact issue, we had to work with the programmers for our billing system and get a work around on this issue.

Erica

 

[mitchellde]

with the modifier 33 (PT for Medicare) it should not be the issue iot used to be, just link both dx codes to the procedure, the modifier will do the rest.

 

[Peke]

But what do you do when 45380 is not covered w/ v76.51 or proctitis?

 

[sheardmd]

I have run into this situation as well. The only way to get this paid that I am aware of is to change this to the G code, either G0105 or G0121 for high-or-low risk. You don't get paid for the biopsy, but at least you get paid. Maybe we are doing it incorrectly, but this is the only way that I am aware of that you can get paid from Medicare in this situation.