Screening colonoscopy w/v12.72

[zita]

If a pt has a history of polyps (adomatous) but no symptomps and would like to get a screening colonoscopy what would you use as his/her prime diagnostic code V12.72 ...or v76.51 and v12.72...

 

[ChristineA]

I would use V12.72. Just out of curiosity when was their last procedure done and have they changed insurance companies from a commercial insurance to Medicare?
We have a lot of patient's who want us to bill a colon screen because they say their insurance will only pay for a screen but their last colon showed adenomatous polyps but I bill the V12.72 if you have a hx of adenomatous polyps

 

[syllingk]

by the way, cms considers that a surveillence colonoscopy, not screening.

 

[Colliemom]

Once the patient has a history of adenomatous polyps, colorectal cancer or inflammatory bowel disease they would no longer have a "screening" colonoscopy.

Use the V12.72, and if it is a commercial payor use the -33 modifier. Use the -PT modifier if it is a Medicare plan.

 

[ssmith955]

V12.72

So the jist is that V12.72 will always be considered a diagnostic procedure? If that is the case the the insurance companies reps who are selling the product should NEVER tell the employees that their package covers colonscopies even if they are at high rick due to hx of polyps v12.72. So in a way all our troubles with patients complaining is that they have been misled by their insurance broker and the HR department of their company

 

[ssmith955]

V12.72

Thank you all for your replies, this is like banging head against the wall. We tell the patients that the V76.51 can never be used again once a patient has a hx of polyps. We do use the 33 or PT modifier on the CPT. Thank you all again for the input

 

[syllingk]

The scopes are usually covered but not under any preventative policies. You would not use a modifier because that is telling them it was preventative turned diagnostic.