Mod 25 and G0121...

BABS37

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Why are you coding an office visit with a colonoscopy screening on the same visit? Normally, you have to prep for a colonoscopy so just curious is all. I haven't ever coded an E/M level with my colonoscopies on the same day with an office visit for my general surgeon.

Otherwise, to answer your question, G0105 Colorectal cancer screening; colonoscopy on individual at high risk and G0121 Colorectal screening; colonoscopy on individual not meeting criteria for high risk are both for Medicare.

If there is a procedure performed at the same time as an office visit, depending on the documentation and what supports it, then yes, you would need a 25 modifier on the E/M level.
 

BABS37

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hey, I spoke too soon yesterday- I had an ER visit with a colonoscopy due to some heavy bleeding :) So guess they do both at times lol! They just prepped the patient and admitted him until his procedure.
 

syllingk

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Medicare won't pay for an office visit prior to a colonoscopy for screening unless it is a personal history. I can't remember right now if they will pay for the visit if it is high risk for family reasons.
 
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