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Medicare Screening colonoscopy

  1. Default Medicare Screening colonoscopy
    Medical Coding Books
    I know that Medicare pays for a screening colonoscopy with G0121 with v76.51 for the surgeon...but is there a special code to use to get the anesthesia for this screening procedure covered as well? This is performed as an outpt procedure with MAC. I used 00810 with v76.51 which was denied as routine services not covered, and the surgeon was paid using the screening codes... I called SC Medicare, who said the MAC was ok, but that the V76.51 was not allowed...Any suggestions?


  2. #2
    Could get a copy of the Op Report for the Post Operative Dx that might be different or if there was secondary Dx for the Pre Operative Dx that you could use.

  3. #3
    Default Lcd
    How to get reimbursed will largely depend on what state the service was rendered in. Your best bet is to pull the LCD for the state. This is available off of the MAC website (e.g. Noridian, Palmetto, Trailblazer, etc). Once you have done this, you will then need to list the co morbidity as the primary dx. Be sure to append the 00810 w/ either a AA or QZ and QS modifier, if your jurisdiction requires it, in order to indicate monitored anesthesia care, which most of these cases are. Please be sure to pull the proper LCD. I do billing/coding for CO, SD, and HI all which have similar yet differant list of qualifying dx codes. If the pt has no documented qualifying co morbidity, then you will need to append w/ a GA if and only if an ABN was secured before services were rendered.

  4. Default screening colonoscopy
    I know Medicare has made changes on how to file for a screening colon when a polyp has been found.
    Am I correct in that you use the 45385 with a primary dx of V76.51 and the 2ndary dx of 211.3, but then put a 2 in the pointer box? What does the modifier of PT stand for?

  5. #5
    Columbia, MO
    I have a problem with changing the primary dx when the purpose of the test was screening. The screening is still the primary dx. If the payer is bundleing the anesthesia into the test then the question to address is can this test be performed safely with out the use of anesthesia. If so then it would be considered patient decision. Or if there is a comorbid reason it would be listed secondary.

    Debra A. Mitchell, MSPH, CPC-H

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