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V76.51 Colonoscopy Screen/Anesthesia

  1. Default V76.51 Colonoscopy Screen/Anesthesia
    Medical Coding Books
    I can't get Medicare to pay our colonoscopy patients that have a code of V76.51. It is denying because it is included in a routine procedure. I don't know if I am missing a modifier or what. Help.

  2. #2
    Default
    V76.51 with Medicare always needs cpt G0121. You will find this code in the HCPCS code book. Medicare never pays V76.51 with 45378.
    Last edited by code3jill; 05-12-2009 at 10:20 PM.

  3. #3
    Default
    If you are billing anesthesia for the colonoscopy. You will need a diagnosis from medicare's list of "medically necessary" diagnosis to be paid and a signed Advanced Beneficiary Notice for the correct modifier (GZ or GA). Check your local medicare website for their Monitored Anesthesia Care Review Policy.
    IBA_Anes_Billing_(NER*CPC)

  4. #4
    Default
    My coding expertise is in colonoscopies and egds'... if the V76.51 is your primary diagnosis, you must have supporting documentation to show medical nescessity. Most of the time Pennsylvania & Ohio Medicare pays with no problems using the screening code but you must show support. If the patients medical history shows family history of CA, you can use that as your 2nd code to indicate the screening is for the family history of CA (V18.XX)... If you have any questions, please do not hesitate to contact me personally

  5. Default
    I thought G0121 was for facility billing only. We always bill using 45378 and get paid using V76.51.

  6. #6
    Location
    Boise, Idaho
    Posts
    424
    Default
    Are you trying to bill conscious sedation? Because that IS included but if they needed another form of anesthesia it should be billable. Need to make sure you have the dx for it though. Do they take pain meds for chronic pain? etc. You need the reason the regular sedation won't work for the patient.

  7. #7
    Location
    Boise, Idaho
    Posts
    424
    Default
    Forgot to add did they bill the procedure out with a -23 for the unusual anesthesia?

  8. #8
    Location
    Columbus Ohio
    Posts
    22
    Default
    We bill anesthesia for endoscopies in Louisiana and Texas and you must have a diagnosis to support "medical necessity" for the added sedation and monitoring. CMS bundles "conscious sedation" into the endoscopy codes so you must have a reason for doing extra.
    I know that" TrailBlazer" has an LCD on "Monitored Anesthesia Care" that has a list of accepted diagnosis codes for "medical necessity" and I have found that most insurance companies follow the list.
    Good Luck.

  9. #9
    Default
    A diagnosis to support medical necessity is only required if MAC is administered. In addition to the QS modifier. If done under general, V76.51 should be fine.

  10. Default
    I think this is largely dependant on carrier, as we bill the anesthesia code 00810 with V76.51 all the time to Medicare in 6 different states and never have an issue getting paid.

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