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Anthem BC/BS colonoscopy

  1. #11
    Pensacola, Florida
    Medical Coding Books
    You may want to do some more research on modifier-33. It ismy understanding that if the procedure qualifies, it should be appended to any CPT code that is not inherently a screening code. It doesn't mean that you can only use it when it becomes a therapeutic colon. 45378 is a diagnostic CPT code. I would code it as 45378-33/V76.51.

    Bridgette Martin, LPN, CPC, CGIC

  2. #12
    I find that quite a number of payors in our area want/expect the G0121 and G0105 codes for screening colonoscopies. I agree that it is a game they play but try those codes. I know from experience that BCBS will pay those codes.

  3. Default
    For my local Blue Cross they have advised us that they regonized the modifier PT, which indicates that a colorectal cancer screening test was converted to a diagnostic test, this is from their provider notification letter. In addition, they have indicated that modifier 33 is to be appened to services whom meet the preventative services as recommended by the US Preventative Services Task Force (USPSTF). So based on this I would think you may need to append modifier 33..
    Sonja Little, CPC

  4. #14
    Maybe you should try submitting G0121/V76.51

    You should probably talk to your rep to find out how they want them submitted?

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