Colonscopy/screening/polyp

[rdavies]

Patient finds out she does not have screening colonscopy coverage. A polyp is found and removed. 33 modifier was on the claim with the screening V code. Is there a different way this should be coded because the 33 and V diagnosis code seems redundant to me. 33 is telling the carrier we started screening the went diagnositic then we are still submitting a screening diagnosis code. If there was no polyp found the patient would be responsible for full charges. It seems to me we have medical necessity with the procedure and the path report. Any supporting documentation would help with the appeal the patient is going to file with her Blue Shield insurance. Thank you.

 

[mitchellde]

It is correct to use the V code for screening first listed since that was the reason for the procedure, it also correct to bill the polypectomy code with the 33 modifier. If there is no polyp or any other findings then bill either the G code for screening colonoscopy or the CPT code for diagnostic colonoscopy with the 33, it depends on payer preference. You cannot bill this any other way if the reason for the procedure was screening. If the patient has no screening benefits, then she knew this before there were abnormal findings.