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Mod 25 and G0121...

  1. #1
    Default Mod 25 and G0121...
    Medical Coding Books
    Good morning all!

    Should Mod 25 be used with an office visit and G0121 for Medicare?

  2. #2
    Default
    Why are you coding an office visit with a colonoscopy screening on the same visit? Normally, you have to prep for a colonoscopy so just curious is all. I haven't ever coded an E/M level with my colonoscopies on the same day with an office visit for my general surgeon.

    Otherwise, to answer your question, G0105 Colorectal cancer screening; colonoscopy on individual at high risk and G0121 Colorectal screening; colonoscopy on individual not meeting criteria for high risk are both for Medicare.

    If there is a procedure performed at the same time as an office visit, depending on the documentation and what supports it, then yes, you would need a 25 modifier on the E/M level.


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  3. #3
    Default
    Thank you!

    Something didn't gel right with me on this, thank you for clearing it up!

  4. #4
    Default
    hey, I spoke too soon yesterday- I had an ER visit with a colonoscopy due to some heavy bleeding So guess they do both at times lol! They just prepped the patient and admitted him until his procedure.


    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  5. #5
    Location
    Boise, Idaho
    Posts
    424
    Default
    Medicare won't pay for an office visit prior to a colonoscopy for screening unless it is a personal history. I can't remember right now if they will pay for the visit if it is high risk for family reasons.

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