Wiki Preventive Screening Colonoscopy with Conscious Sedation going to deductible

[Janelle926]

I have been seeing a lot of conscious sedation codes (G0500/99152/99153) on preventive screening colonoscopy's (G0121/45378, with Z12.11) that are going to the patients deductible.

The colonoscopy itself is being paid at 100% but not the sedation codes. I'm not sure why this is, I have been doing research and I can't really find anything about sedation codes for preventive colonoscopy's. Here is a write out that a patient of our's received from Cigna. "You are correct that anesthesia for screening colonoscopy should be covered at 100% of the provider's contracted rate with no cost sharing yet the code the provider billed is not the listed procedure we consider as preventive."

we billed:
G0121 - Z12.11 - paid 100%
99152 - Z12.11 - went to the patients deductible
99153 - Z12.11 - went to the patients deductible

Can anyone please HELP me??

 

[CodingKing]

They might need modifier PT/33 on the anesthesia.

 

[thomas7331]

This is clearly Cigna's error - on their own web site they state that if "a colonoscopy is performed as a preventive screening, any related anesthesia services must also be covered at 100%" and they acknowledged this to you in their response. The fact that the codes are not on their 'list' is not a valid excuse to pay the incorrect benefits. If they want you to code this differently, they should to have some published policy as to how they want it coded so that they will recognize it and pay correctly. I would push back on this, and ask the patient to contact them as well. These are new codes for 2017, so perhaps they will discover the problem and correct it soon.

 

[awalker28]

I am having the same issue with Bluecross ALA and Humana?


But in BC ALA policy is states to report diagnosis Z1211 with moderate sedation code 99152/ G0500.....BUT they are not paying and this policy was revised 4/27/17......