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Thread: Medicare History of Polyps

  1. #1

    Default Medicare History of Polyps

    A Medicare patient with a personal history of polyps comes in, removed a polyp (2 polyps)coming back in 3-5 years
    Report states this is a surveillance ( last colon 3 years ago, removed polyp)
    If we follow Medicare guidelines, Medicare pays for a screening colon due to personal history of polyps every 24 months. How can we code for a screening when the doctor refuses to put screening and always has report as a surveillance? Shouldn't we be coding 45385 PT Modifier w/ Z860.10 as primary dx and D12.0, D12.6. If we code as surveillance, the patients deductible applies as well as their coinsurance. If its a screening, deductible is waived. I feel these patients should not be billed for deductibles since Medicare guidelines states they are allowed 1 screening every 24 months.
    Can I get some else's opinion?

  2. #2

    Default Re: Medicare History of Polyps

    In this case, we usually code the polyp first then PHCP and use the PT modifier. We have found that this also works for most commercial payers as well but the PHCP goes first on those claims.

    I also found this on AAPC's site:
    "...Medicare Part B claims that originate as a screening or surveillance and result in a therapeutic procedure (e.g., polypectomy), we report the appropriate CPT code with modifier PT for patients either at low-risk (e.g., a principal diagnosis of V76.51 Special screening for malignant neoplasms of colon) or high-risk (e.g., a principal diagnosis of V12.72 Personal history of colonic polyps)."

    I hope this helps.
    Jackie

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