cedwards
Guru
40 year old patient with APC I1307K had a screening colonoscopy in October 2025. Decided to not have DDAVP prior to the procedure. Was advised if there was a finding would have to come back at a later date for DDAVP prior to the procedure. A 5 mm polyp was found in the sigmoid colon but was not removed because the patient needs to be on DDAVP. Repeat colonoscopy for polypectomy was done with patient on DDAVP in February 2026. How would you bill the second colonoscopy? We billed 45385 with D12.5. Patient is getting a large bill. Per patient insurance states procedure needs to be submitted w/screening primary, APC gene, fhx, phx, dx for why she needs infusion & findings. The provider doesn't believe this should be screening because he knew the polyp was there and the intent was to remove it. He is willing to write a letter to the insurance to explain what occurred.