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Thread: Screening VS Diagnostic Colonoscopy

  1. #1

    Default Screening VS Diagnostic Colonoscopy

    AAPC: Back to School
    Need some coding assistance regarding screening vs diagnostic colonoscopies.

    When a patient comes in for a screening and a polyp is found, removed and sent for pathology, or a biopsy is done, would you code V76.51 first and then the result such as benign neoplasm of colon, 211.3 etc..? Or do you code the findings?

  2. #2


    You would post the V76.51 first and 211.3 second.

  3. #3


    If I understand correctly, you would also add the PT modifier that is new for 2011 when this happens. I am still new to billing for GI claims, so if I am incorrect, I hope someone will reply. I am still waiting for my clinic to add the PT modifier in their EHR system so the claims I am holding for this reason, have not gone out yet.

  4. #4
    Join Date
    Apr 2007
    Redding, CA


    I'm not sure that you need to use the PT modifier for all payers, but I do know that you need to use it for MCR. The other payers may follow suit, but I haven't received any info on this yet. But yes, you would use the V76.51 first, and the 211.3 second. :0)

  5. #5
    Join Date
    Apr 2007


    You would use Mod 33 for other payers.

  6. #6

    Default Modifier PT

    We have been using the Modifier PT...it was my understanding that if this was used that Medicare would not leave a co-pay for the patient since this is a flag for "screening". They have left a balance for all of the patients we have billed so far. Has anyone else having this problem?

  7. #7
    Join Date
    Apr 2007


    Only the deductible is waived with modifier PT. See this MLN Matters, in the last paragraph addressing modifier PT: http://www.cms.gov/MLNMattersArticle...ads/MM7012.pdf
    Jenny Berkshire, CPC, CEMC, CGIC

  8. #8
    Join Date
    Apr 2007
    Mesa Arizona


    The only procedures that Medicare are going to be paid in full without a coinsurance are the screening colonoscopies with no additional findings or intervention. Example the G0121 and G0105 avg risk, and high risk paired with the V76.51. As the year goes on the PT modifier becomes less significant as most medicare patients have met their deductible.

    I have checked with several of my local commercial carriers and many of them do not recognize or will not start recognizing modifier 33 until April. In other areas what impact is modifier 33 having on screening turned diagnostic colonoscopy claims processing?

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