1. N

    Using Z12.11 for both polyp removals for colonoscopies

    Has anyone seen if there's been a coding change regarding colonoscopies? When a patient has a screening colonoscopy, I of course use Z12.11 as the primary code, followed by polyp codes (if found). I've had a couple remits come back where they paid for 45385, but are putting 45384 towards their...
  2. R

    Question Colonoscopy w/ Snare Biopsy - missing path

    When working a procedure where the documentation supports 45385 but the resulting lab sample is lost - is the procedure still coded snare biopsy? How does this effect dx?
  3. P

    Question 2020 Excludes 1 note on k63.5 and D codes

    There is a new excludes 1 note on K63.5 (polyp of colon) and all D codes (adenomas of colon). As anyone who codes endoscopies knows, it's very common for hyperplastic polyps to exist along with adenomatous polyps, in the same area of the colon or in other areas... so I am confused as to why this...
  4. G

    Colonoscopy Consults

    Help Please, We are struggling with finding information regarding colonoscopy consults. We are aware CMS does not allow, however there is never any discussion around a consult not performed on the same day as the procedure. For example: Patients PCP deems it time for patient to have a colo...
  5. N

    colonoscopy pre op visit

    I am new to gasto coding and have a question. It is my understanding we cannot bill for the pre op visit for a colonoscopy if it is done within 24 hours as the pre op is part of the colonoscopy service. But help me with these scenarios. The patient goes to the family doc because they are age 50+...
  6. A

    Colonoscopy with balloon dilatation

    Hello fellow coders, I'm in need of your opinions on the coding of the below op report. Optum is denying my claims stating that the services are not supported due to no documentation within the op report that the colonoscope went to the cecum. Per CPT book the definition of a colonoscopy is...
  7. G

    Colonoscopy Consult

    We are struggling to educate providers on appropriate level for screenings when there are no symptoms present other than patient age and or history of never having a colonoscopy. We are also questioning whether or not these types of screenings should be billed as everything we've found states...
  8. G

    Colonoscopy Consults

    We are struggling to educate providers on appropriate level for screenings when there are no symptoms present other than patient age and or history of never having a colonoscopy. We are also questioning whether or not these types of screenings should be billed as everything we've found states...
  9. S

    Op Report Required Elements

    Hello there! Finally have time to get a little more in depth with the quality of all of our documentation. I am curious if anyone has any good resources to confirm CMS requirements for the components of an op report, specifically for colonoscopies. At this time we are watching out for the...
  10. E

    ASA base units for 00811 and 00812 for commercial payers

    Can the ASA base units for 00811 and 00812 be raised to 5 units for commercial payers? Per Anesthesia Guidelines on pg. xi in the RTV guide states Any procedure around the head, neck, or shoulder girdle, requiring field avoidance, or any procedure requiring a position other than supine or...
  11. E

    Coding Clinic States use Z12.11 on High Risk Screening Colonoscopy???

    I reviewed documentation from a recent AskMueller seminar of GI coding and billing and it states to assign Z12.11 screening for malignant neoplasm as the primary diagnosis code for high risk screening colonoscopy, stating a surveillance colonoscopy is a screening colonoscopy. I had never heard...
  12. J

    Office Visit Before Colonoscopy (medicare)

    Medicare patient here for Office Visit before setting up a Colonoscopy, due to Personal History of Colon Polyps. Sent for EKG - will possibly need clearance before procedure, am I correct that I cannot charge for this visit as it is included in the Medicare global fee for Colonoscopy?
  13. E

    Z80.0 clinical edit error BCBS Michigan

    Anyone experiencing denials for Z80.0 with BCBS? I've run into several plans that are denying Z80.0 (family hx colon cancer) as an invalid ICD10 code for high risk screening colonoscopy. I've talked with provider services, reported the issue and believe since Oct 1st they have an error in their...
  14. J

    Surveillance Colonoscopy vs Screening

    I am beyond confused - I keep reading how to code screening vs surveillance colonoscopies and found this article which goes against everything I've been reading. Thoughts? On this site...
  15. J


    hello all. We will be performing colonoscopy as part of work up for cardiac transplants. How do I code for this? For instance, I have a medicare patient scheduled that had her last colonoscopy 3 years ago and it was normal. Is it a screening? Z12.11? Is it an exam prior to cardiovascular...
  16. J

    Preventive Screening Colonoscopy with Conscious Sedation going to deductible

    I have been seeing a lot of conscious sedation codes (G0500/99152/99153) on preventive screening colonoscopy's (G0121/45378, with Z12.11) that are going to the patients deductible. The colonoscopy itself is being paid at 100% but not the sedation codes. I'm not sure why this is, I have been...
  17. S

    What anesthesia type for colonoscopy

    What anesthesia type do you bill for a colonoscopy?
  18. T

    Payor Guidelines

    I am the office manager of a small GI group. I was recently told we need to verify every procedure to make sure prior authorization isnt needed. I am curious as to if there is a data base out there that you can enter your insurance ID/Group etc. in and pull up rather PAs are needed? or is there...
  19. J

    2017 moderate sedation - multiple procedures, same dos

    Our physician is coding 45380 & 45385 with 99152 & 99153. Additionally, he's also coding 43235 with 99152. Does anyone know if we are allowed to bill 99152 twice? Also, if billed twice is modifier 59 appropriate on the second 99152? :confused:
  20. Lisa Griffin

    colonoscopy screening vs colonoscopy diagnostic

    Hi, Question, we seem to be having some confusion when it comes to ordering colonoscopies. For simple, asymptomatic patients who just need a screening we are using Z12.11 plus 45378. It seems that this confuses some of our patients when they see that 45378 is colonoscopy, diagnostic. If we are...
  21. T

    G0105 Billed with dx Z12.11

    I am sure that this has been hashed out over and over with little clarity on the internet and in posts. Case in point: Medicare patient with Crohn's. No Crohn's symptoms for over a year. Obviously high risk, G0105. Patient comes in for a screening colonoscopy. The question.. Is using...
  22. C

    Coding multiple excision on same level

    I am trying to gather resources to help in responding to a provider regarding scope coding. We have a case where two lesions both at the level of the sigmoid were removed, one by snare and one by forceps. The provider feels he can code both 45385 and 45380 and feels that all the respurces I...
  23. L

    Intraop colonoscopy for lesion ID and transanal specimen extraction

    I have a question on how exactly this c-scope should be coded.....the patient had a robotic assisted colotomy, polypectomy, with intra-op c-scope and polyp removal. There is one Dr doing the colotomy and polypectomy with another one of my physicians is doing the intra-op c-scope, here is the...
  24. M

    Should modifier 74 be added????

    I have a colonoscopy-- facility coding. Physician completed a polypectomy in the sigmoid colon and was in the process of doing a polypectomy in the cecum when the patient developed tachycardia and he aborted the procedure. He does state in his OP note that he will report the colonoscopy in the...
  25. L

    Colonoscopy - Biopsy, then fulguration

    I have a DR who does a lot of colonoscopy's. I have been coding them for about 6 months, but am now training another individual, so I am second guessing a couple things. All help would be appreciated. Dr states: "In the mid rectum, she had 3-4 small polyps the I cold biopsy x2 and then...
  26. A

    Consult before Colonoscopy

    Can I get feedback on how you are billing your consults before a colonoscopy? Thank you very much for your time!
  27. K

    incomplete colonoscopy due to poor prep, with same day complete colonoscopy

    Patient was scheduled for a complete colonoscopy. Due to poor prep, the colonoscopy was halted at the hepatic flexure. (45378-53,33). After several hours and another prep the same day, the patient had a complete colonoscopy, 45378-33. Is the first, same day, incomplete colonoscopy billable? or...
  28. U

    Colonoscopy in outpatient setting

    Hello. Wanted to get some clarification. :) Colonoscopy- physician introduced scope through anus and advanced to the terminal ileum, with ID of the appendiceal orifice and IC Valve. The colonoscopy was performed without difficulty. The quality of the bowel preparation was fair to poor. He did...
  29. T

    Medicare Pt. Office Visit prior to colonoscopy

    I have a physician who saw a patient in clinic today prior to her being scheduled for a colonoscopy. Patient has a history of PE and is on anticoag therapy. He is doing a lovanox bridge with this patient, and took a great amount of time with her to explain all of this. Can he bill the office...
  30. A

    Colonoscopy coding - When coding for the physician

    When coding for the physician preforming the colonoscopy, is it ok to just code the colonoscopy from only the op note and not look back at the H & P or Pre op notes? I have heard some other coders are doing this. The reason I ask is that a Dr. may mention symptoms (rectal bleeding possible from...
  31. S

    Outpatient colonoscopy

    Hello everyone. I am a coder but do not code for facilities and I am having a personal issue with the hospital coding. 5 years ago I had 1 polyp that turned out to be tubular adenoma. resection fof 12 in of my intestine. Had a repeat colonoscopy 2 years later. I went in again recently for a...
  32. S

    Incomplete EGD-Opinions please!

    Opinions please! :) I have a patient who was scheduled for an EGD and colonoscopy. The EGD was unable to be completed due to the patient having a very small mouth and torticollis. They were unable to even insert the mouth guard in the patient's mouth. The patient was already sedated, but was...
  33. A

    Aborted Colonoscopy

    In the 2015 CPT book, I was informed in multiple meetings that the "Colonoscopy Decision Tree" found right before the Sigmoidoscopy section was incorrect. I was told that when the colonoscopy didn't reach the splenic flexure, we were supposed to still bill the colonoscopy but with the...
  34. A

    Medical Paying G6021 for Colonoscopy with EMR

    Medicare Paying G6021 for Colonoscopy with EMR Has anyone had any luck getting Medicare to pay G6021 for a colonoscopy with EMR? The CPT code is 45390.
  35. M

    Colonoscopy Medical Decision Making Risk

    I am in the process of conducting an E&M audit for a gastroenterology practice. The majority of the patients are being seen for evaluation and subsequent scheduling of a colonoscopy. Most are due to family history and preventive reasons. While endoscopic procedures do carry risk i'm just not...
  36. P

    NEED FAST HELP re; G0105

    Hi all, I'm hoping to get some fast help on this topic as we run into this scenario all the time at our facility and us in coding keep butting heads about the right way to go about it. There does not seem to be clear documentation out there as to when a patient is considered "high risk" allowing...
  37. B

    Colonoscopy with dilation plus biospy

    One of our Dr.'s preformed a colonoscopy with dilation at the termial ileum while doing this procedure he also obtained a biopsy. Should I just be coding the colon w/dil? or should I also code the biopsy? Hoping someone can offer some advice. Thank you.
  38. L

    Facility reimbursement for multiple colonoscopies

    Should facilities be paid for multiple colonoscopies performed on the same date for same patient? For example: 45380 & 45385 (billed with mod -59). A Medicare RAC report reported that hospitals should not be paid for more than one colonoscopy per day per patient. However, different facility...
  39. D

    Screening Colonoscopy Coding

    I have worked at an ASC for 7 years. At a round table the other evening, a hospital coder said that if a patient is booked for a screening colonoscopy, and a polyp is found- code V76.51, followed by 211.3..... I was always taught that in this instance the procedure becomes surgical and to code...