Wiki screening flex sig/Medicare

[anknight77]

We have a Medicare patient that had a polypectomy in July and the dr brought her back in this month for a flex sig to see if there were any residual polyps. This was coded as G0104with V12.72 (hx of polyps) as the diagnosis. Medicare has denied the claim stating the diagnosis is not covered. Is this technically a screening flex sig, or should it be coded as 45330 with V12.72? Thanks in advance for your help!!!

Amy

 

[coachlang3]

I personally would code 45330 with a 211.3 (or 211.4). It is not a screening per Medicare guidelines (based on time limits) so you wouldn't use the the G code.

 

[mitchellde]

I personally would code 45330 with a 211.3 (or 211.4). It is not a screening per Medicare guidelines (based on time limits) so you wouldn't use the the G code.

You cannot use the 211.x codes as this is not the patient's dx at this encounter. if the polyps had been benign then that dx has been taken care of and the patient no longer has that and it is not the indication for the flex sig. It is for follow up purposes so you should use a followup code from the V67.x for follow up following procedure.

 

[eescalante]

I personally would have coded this as a 45330 with V12.72. Medicare likely will not cover that - but that's the accurate coding. The patient already had their screening flex sig - so this one is a diagnostic procedure performed because the patient has a history of polyps.

I would have had the patient sign an ABN, informed him/her that the procedure may not be covered and then gone from there. If the patient proceeds with the procedure and it denies, then (if the ABN is signed) bill the patient.

 

[coachlang3]

oh, gotcha Deb, thanks.