2015 code revisions for lower GI get a bit confusing with the deletion of 45383 (colonoscopy w/ablation). It was replaced with 45388 (Commercial) and G6024 (Medicare).
All is fine until a Medicare patient has a screening colonoscopy that turns diagnostic because polyps or lesions were removed by ablation.
Last year this scenario would have been reported to CMS as 45383 PT V76.51, 211.3 (payable claim).
This year, per Medicare guidelines, this is reported as G6024 PT V76.51, 211.3 (claim denied for "invalid use of modifier").
Medicare's 2015 Fact Sheet for modifier PT does not include the new G codes - "append modifier PT to CPT codes in the range 10000 to 69999" with no mention of their new G codes.
On a positive note, 2015 NCCI edits allow G6024 with modifier 59 when used with 45382, 45384 and 45385.
CMS has been notified of the oversight.
pulsepointbilling.weebly.com/
All is fine until a Medicare patient has a screening colonoscopy that turns diagnostic because polyps or lesions were removed by ablation.
Last year this scenario would have been reported to CMS as 45383 PT V76.51, 211.3 (payable claim).
This year, per Medicare guidelines, this is reported as G6024 PT V76.51, 211.3 (claim denied for "invalid use of modifier").
Medicare's 2015 Fact Sheet for modifier PT does not include the new G codes - "append modifier PT to CPT codes in the range 10000 to 69999" with no mention of their new G codes.
On a positive note, 2015 NCCI edits allow G6024 with modifier 59 when used with 45382, 45384 and 45385.
CMS has been notified of the oversight.
pulsepointbilling.weebly.com/