screening colo and medicare

[rmilly]

We recently had a medicare denial, for G0121-V76.51. We are still looking into this, but during our conversation. I was told when billing G0105 we do not use V76.51. The V-code is only used on low risk screenings. Is this correct ?

 

[scorrado]

G0105 is done for a patient who is at "high risk" so you need to use a diagnosis that reflects that. V7651 would not be appropriate but V1272 - personal hx of colon polyps,
V1005 - hx of colon cancer, and V160 - family hx of colon cancer would be considered high risk and appropriate to bill with G0105. Hope this helps!

 

[rmilly]

Thank you for the help.

 

[missyah20]

I have a question regarding billing a screening colonoscopy and Medicare. We have a patient who had a primary insurance of Multiplan. The hospital did not obtain a pre-auth and it was therefore denied. Medicare is the patient's secondary insurance. Since Multiplan was primary we billed with a dx of V7651 and a surgical code of 45378. Now Medicare is denying for medical necessity. Since the primary payer did not pay can we bill with code G0121 for Medicare secondary or do we need to follow the Medicare LCD for diagnostic colnoscopy?

 

[scorrado]

Missyah- you can bill the G0121 to Medicare secondary if it is for screening.