Results 1 to 5 of 5

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
    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
    Thank you!

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

  4. #4
    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
    Boise, Idaho
    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.

Similar Threads

  1. G0121 not covered??
    By AdamShoop in forum Gastroenterology
    Replies: 3
    Last Post: 05-08-2014, 11:51 PM
  2. 45378 or G0121
    By vajohnson1213 in forum Gastroenterology
    Replies: 2
    Last Post: 06-30-2011, 09:13 AM
  3. Code G0121
    By helene73 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 02-12-2010, 07:30 AM
  4. g0103 and g0121
    By bwerner in forum Modifiers
    Replies: 1
    Last Post: 08-14-2008, 06:06 PM
  5. g0121
    By bwerner in forum Gastroenterology
    Replies: 1
    Last Post: 08-13-2008, 03:11 PM

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.