AAPC - Back to school
Results 1 to 5 of 5

Thread: Medicare Screening colonoscopy

  1. #1

    Default Medicare Screening colonoscopy

    AAPC: Back to School
    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
    Join Date
    Apr 2007


    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
    Join Date
    Apr 2007

    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. #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
    Join Date
    Apr 2007
    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

Similar Threads

  1. Medicare screening colonoscopy over age 75
    By dsmith1979 in forum Gastroenterology
    Replies: 0
    Last Post: 10-07-2015, 11:28 AM
  2. Denial for Medicare screening colonoscopy
    By JDV7980 in forum Gastroenterology
    Replies: 2
    Last Post: 08-19-2015, 05:10 PM
  3. Billing Medicare Secondary for Screening Colonoscopy
    By cedwards in forum Gastroenterology
    Replies: 2
    Last Post: 07-18-2013, 02:47 PM
  4. Medicare pt screening colonoscopy scenerio
    By busydawnis in forum Gastroenterology
    Replies: 11
    Last Post: 08-21-2009, 06:41 AM
  5. Medicare Screening Colonoscopy
    By coderguy1939 in forum Gastroenterology
    Replies: 4
    Last Post: 01-01-2009, 12:38 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.