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General Surgery Coding Alert

You Be the Coder:

PT Paves the Way for Diagnostic Colonoscopy Pay

Question: A screening colonoscopy for a patient resulted in a biopsy. The patient has Medicare, and when I billed 45384, Medicare paid at 80 percent of the allowable. The patient told me that Medicare is supposed to cover screening colonoscopies at 100 percent per his handbook. Is this correct, and if so, how should I code this?Rhode Island SubscriberAnswer: The patient is correct that Medicare covers screening colonoscopies at 100 percent (assuming appropriate age, frequency, and ordering diagnosis), but that diagnostic colonoscopies are subject to deductible and coinsurance. Medicare provides two "G" codes for screening colonoscopies: G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk) for an average-risk patient receiving a screening colonoscopy, or G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) for a high-risk patient. You would expect the physician to order a screening test in the absence of signs or symptoms of [...]

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