Results 1 to 8 of 8

Screening VS Diagnostic Colonoscopy

  1. Default Screening VS Diagnostic Colonoscopy
    Medical Coding Books
    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
    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
    You would use Mod 33 for other payers.

  6. Default Modifier PT
    We have been using the Modifier 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
    Only the deductible is waived with modifier PT. See this MLN Matters, in the last paragraph addressing modifier PT:
    Jenny Berkshire, CPC, CEMC, CGIC

  8. #8
    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?

Similar Threads

  1. Screening or Diagnostic Colonoscopy
    By mdwyer in forum Gastroenterology
    Replies: 2
    Last Post: 07-07-2015, 08:22 AM
  2. Screening vs. Diagnostic Colonoscopy
    By torifreak12 in forum General Surgery
    Replies: 4
    Last Post: 03-26-2015, 08:27 AM
  3. screening vs diagnostic colonoscopy
    By kjhamm55 in forum Medical Coding General Discussion
    Replies: 5
    Last Post: 09-07-2012, 06:04 AM
  4. Diagnostic/Screening Colonoscopy
    By NESmith in forum Gastroenterology
    Replies: 1
    Last Post: 03-23-2010, 08:24 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.