Screenings under 45 / Family History

[rebelhotspur]

How would you bill for a first time colonoscopy where the patient is under 45 and has a strong family history of colon cancer in 1st degree relatives?

My physician has coded 45378 - Z1211, K648, Z800 but I've always been told the Z-codes are not billable for under-45 yr olds.

How would everyone else bill this? TIA

 

[lgardner]

per AAPC:

Let’s look at a few coding examples for various colorectal cancer screening encounters.

Scenario 1:

Indication: Family history of colon cancer

Procedure performed: Screening colonoscopy

Coding: G0105, Z80.0 for Medicare patients (no cost-sharing)

45378-33, Z80.0 for Medicaid and commercial patients

Rationale: For Medicaid and commercial patients, append modifier 33 to the CPT® code to eliminate patient cost-sharing (copay, coinsurance, and deductible).