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Screening Cscope vs UHC

  1. #21
    Default
    Medical Coding Books
    How can you code V7651 with G0121 every two to five years when a patient has a history of colon polyps when Medicare only pays for that every 10 years? If you are getting paid for this combination please let us in on the secret because I have never had a screening colo paid any sooner than 10 years by Medicare.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  2. Default
    Quote Originally Posted by slpagel View Post
    Pt came for a screening Cscope. He has a history of polyps V12.72. The claim was submitted with G0105 for the CPT and V12.72. United Healthcare is claims that this is diagnostic. Has anyone else have this problem?
    On the Left Coast, we only use the "G" CPT codes when billing Medicare. Do you have a contract with United? If so, go to their website or call them for guidelines as to their preference when billing screening Colo claims. Most of our contracted carriers will tell us the order they prefer the DX codes for screenings. Much luck to you...

  3. #23
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by scorrado View Post
    How can you code V7651 with G0121 every two to five years when a patient has a history of colon polyps when Medicare only pays for that every 10 years? If you are getting paid for this combination please let us in on the secret because I have never had a screening colo paid any sooner than 10 years by Medicare.
    I never intimated that Medicare or any other payer paid this I stated I felt this was the appropriate way to code it based on the information that the patient was here for screening due to a hx of polyps. Payment will be based on medical necessity and benefits.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    I agree. Pt came for SCREENING. V76.51 gives the reason.

  5. #25
    Location
    Greeley, Colorado
    Posts
    2,045
    Question
    I guess what I am looking for is documentation to tell me that a history of equates to screening and therefore the history code is second... I can't seem to wrap my mind around the fact that screening can be performed on someone with a history of polyps since said history is the true reason for the procedure. I truly appreciate everyone's input here! I want to code these the right way!
    Lisa Bledsoe, CPC, CPMA

  6. #26
    Default
    I love reading everyone's opinion on this issue also. We are all very passionate about what we do that is obvious so I guess that means we are in the right jobs. LOL!
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

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