Wiki medicare colonoscopy 45378

[Lbooth110]

I am new with General Surgery. I am aware that there are main guidelines to follow. But i would like to better understanding the rules for Medicare. i also went to the medicare website. Based on what I have read on the other message threads Medicare requires V76.51 as the primary diagnosis when billing a 45378?

Here is a what if senario: (Medicare)

There is pt in the hospital that was admitted for Abd pain and Blood in stools. Doctor stated he did a 45378 (screening/diagnositc colonoscopy).
Op states no significant problems and only finds hemorrhoids, which is probably the reason for the blood in stools. Would this still only be a
V76.51 as primary and 45378??

Thank you in advance,
L

 

[mitchellde]

It is never a screening if the patient is symptomatic. If the patient request a screening then they cannot have acute abd pain and blood in stools as a complaint/reason for the test. therefore you would not use the V76.51 at all.
If the patient is asymptomatic at the time the test is requested and it is screening, then you do code the V76.51 first and if there are no abnormalities then code the colonoscopy using a G code not the 45378.
if the only abnormality is hemorrhoids the still use the G code for the procedure and the V76.51 first listed
if the colonoscopy finds say polyps that are removed then the V76.51 is still coded first listed, and you use the CPT code for colonoscopy with polypectomy and append a PT modifier.

 

[Lbooth110]

1.Ok, if it was a screening but there was a polyp removed then it would be 43580 w/mod PT? correct?

2.This pt has Medicare and was in the hospital with blood in stool, abd pain and after colonoscopy they discovered a very small hemorrhoid. Which he left alone. Only a diagnostic colonoscopy. So, would I still use 45378 w/V76.51 as primary dx and blood in stool secondary then hemorrhoid thrid dx?

3.Based on what I read in medicare and threads, Medicare will only cover a 45378 if you use a V76.51. That they will not even consider your claim if you have any other dx 1st other than the V76.51. Is this true??

Thank you for your help,
L

 

[mitchellde]

If the pt was in the hospital with abd pain and blood in stool then you would not use a V76.51 at all, it cannot be a screening if the patient is symptomatic.
Medicare does not accept the 45378 for a screening colon it must be the G code.