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Back to 45378 vs. G0105

  1. #11
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    Quote Originally Posted by coachlang3 View Post
    No, if the patient came in for a screening the proc code would be G0105 and V12.72. The pt is high risk (G0105) due to previous findings (V12.72). The only time you would need to code the 45378 would be if the patient presented with current symptoms but there were no findings. This is for Medicare. However, other insurances don't like the G codes so you would need to use the 45378.
    i agree with this from coachlang.....and also, medicare will not pay for the screening G0105 when billed/coded with the V76.51, we have been getting plenty of denials for medical necessity but they will pay for the V12.72 along with the V10.05, V10.06 and V16.0....there are limited V-codes that warrant payment from medicare.

    And yes, G codes are only for Medicare...other ins will need to be billed the 45378

  2. Default What if
    Very often I have pt's that have their colonoscopies for screenings, and the only finding is diverticulosis w/out hemorrhage (not a covered dx). Is this still a screening since the dx isn't a covered one and what code would i use?
    adrianne, cpc

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