Wiki Pathology 88305 TC for Screening Colonoscopy

[nnicklin]

Hello,
Can anyone tell me where I can find documentation/guidelines on the correct coding for 88305 TC please?
Billing for GI office.
Here is the example: pt has screening colonoscopy and polyps are removed.
45385.PT - Z12.11, D12.1, D12.3
88305.TC - D12.1, D12.3
Is it appropriate to bill with screening diagnosis Z12.11 as the primary diagnosis with CPT 88305.TC? If so is modifier PT or 33 required on the claim?
Does the pathology report have to state screening colonoscopy?
We have been debating this issue for the last couple of years and can't find anything to confirm or deny.
Any help is greatly appreciated!
Thanks
Nancy

 

[agibb1022]

Hello,
Can anyone tell me where I can find documentation/guidelines on the correct coding for 88305 TC please?
Billing for GI office.
Here is the example: pt has screening colonoscopy and polyps are removed.
45385.PT - Z12.11, D12.1, D12.3
88305.TC - D12.1, D12.3
Is it appropriate to bill with screening diagnosis Z12.11 as the primary diagnosis with CPT 88305.TC? If so is modifier PT or 33 required on the claim?
Does the pathology report have to state screening colonoscopy?
We have been debating this issue for the last couple of years and can't find anything to confirm or deny.
Any help is greatly appreciated!
Thanks
Nancy

My understanding is that the pathology codes should include the screening diagnosis if it was a screening colonoscopy. PT or 33 would depend on the payer.

 

[nnicklin]

Thank you for that information Amanda, do you have any references/guidelines that I could take a look at?

 

[danskangel313]

Hello,
Can anyone tell me where I can find documentation/guidelines on the correct coding for 88305 TC please?
Billing for GI office.
Here is the example: pt has screening colonoscopy and polyps are removed.
45385.PT - Z12.11, D12.1, D12.3
88305.TC - D12.1, D12.3
Is it appropriate to bill with screening diagnosis Z12.11 as the primary diagnosis with CPT 88305.TC? If so is modifier PT or 33 required on the claim?
Does the pathology report have to state screening colonoscopy?
We have been debating this issue for the last couple of years and can't find anything to confirm or deny.
Any help is greatly appreciated!
Thanks
Nancy

Modifier PT is for Medicare and Modifier 33 is for other payers.

If the colonoscopy begins as a screening and becomes diagnostic, you don't use the screening code, instead you use a diagnostic colonoscopy code with mod PT or 33. The modifier is there to let the payer know that the service was a screening originally. In the case of Medicare, screenings are at no cost to the patient, but when the code changes to a diagnostic code, they only way for MC to know it was a preventive service is with the application of the PT and ensures the patient isn't charged. The primary DX remains as the screening diagnosis, then additional DX codes are applied to indicate the polyps.

For the pathology charge, the screening diagnosis is inappropriate because the purpose of the pathology services are due to the polyps, not due to a screening. Along those same lines, mod 33 or PT would also not apply to the pathology code.

The example would be appropriate if the patient had Medicare. If it was any other payer, mod 33 would replace the PT.

https://med.noridianmedicare.com/do...entation/27228c29-690e-4b87-b9b4-2410c3f24429
https://nicolettinotes.com/2013/09/26/coding-for-screening-colonoscopies-5/