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Wiki Anesthesia--Colonoscopies

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Marianne Swilley

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We have been having a discussion as to the correct way to bill screening colonoscopies that become diagnostic colonoscopies for Commercial insurance and Medicare Advantage. We agree with Medicare changing to 00811 with PT modifier, but we are not sure if we are supposed to bill the other payers the same as Medicare.
 
Generally, screening colonoscopies that result in a procedure are coded as follows.

For commercial: 00812-PT (check with insurance anesthesia coding policies to be sure, as some may have specific requirements)
Medicare & Medicare Advantage Plans: 00811-PT
 
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