You wouldn't use the G codes in that case. The G codes a specified for Medicare screenings. Some other carriers in different states use them too, but basically if a Medicare patient comes in for a screening colonoscopy and the procedure doesn't change to diagnostic (taking a biopsy, removing a polyp) you would use G0121. If a high risk Medicare patient comes in for a screening colonoscopy(a patient with history of colon cancer, first degree familly history of colon cancer, etc) and the procedure doesn't change to diagnostic you would use G0105. This same rule applies for the sigmoidoscopies, just different G codes. If a Medicare patient comes in for a screening sigmoidoscopy and the doc takes a biospy you would code it as 45331-PT. The PT modifier indicates that he came in for a screening. If the Medicare patient came in for other reasons like diarrhea your would just code the 45331.
Its a good idea to go back in these forums and read some of the discussions. That definitely helped me a lot. There are a few different interpretations of some rules, so make sure to use the http://www.cms.gov website and others for determination.
Sorry if that was a little confusing,
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join