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Billing a high risk colonscopy to Medicare what code do I use?

Marianne Posted Wed 20th of November, 2013 16:53:37 PM

"g0105, 45380"

SuperCoder Answered Wed 20th of November, 2013 18:01:46 PM

Adjust When Screening Becomes Diagnostic

When your Phusician starts out performing a screening colonoscopy for colorectal cancer but ends up addressing another problem during the colonoscopy, you should report the appropriate procedure code and leave G0105 off the claim.

Example: A 61-year-old Medicare patient reports for a high-risk colorectal cancer screening. During the procedure, the Physician finds a pair of polyps, which he biopsies (results come back negative).

On the claim, report 45380 (Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple) for the colonoscopy. Remember to attach 211.3 (Benign neoplasm of other parts of digestive system; colon) to 45380 to represent the patient's polyps.

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