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Hi Camille,
Yes, correct, screening code should be a first-listed code if the reason for the visit is specifically the screening exam
You should use the Z12.11 as first listed ICD-10 for all the payers.
On the other hand, once the physician indicates that the screening procedure has turned diagnostic, you’ll bill only the diagnostic colonoscopy code, and not the screening code (G0104-G0106, G0120-G0121). Not only is this correct coding, but it’s also the only way you can use modifier PT.
For diagnosis pattern, when procedure is scheduled as a screening (colonoscopy) and a polyp is found, guidelines states that whenever a screening examination is performed, the screening code is the first-listed coded. The fact that the test is a screening remains, regardless of the findings or any additional procedure that is performed as a result of the findings. Hence, with screening procedure code, first listed diagnosis will be of screening (Z12.11), then other findings (like, polyps).
Remember that once the polyp is removed the patient follow up visits should not be code with polyp of colon. Then, use code Z86.010, personal history of colonic polyps.
For modifier PT, according to Medicare:
Therefore, you should not append modifier PT to G codes such as G0104-G0121.
According to Medicare rules, you should not use the Modifier PT when the service began as a diagnostic procedure.
Hope this helps!
Hi Camille,
We are working on this, will get back to you soon.
Regards!
Hi Camille,
Hope you are keeping well.
We discussed with the Newsletter Editor, as per our Editor, modifier PT should not be used with the G codes when converted to diagnostic/therapeutic services.
In such cases, appropriate CPT code can be used with PT modifier for Medicare patients and 33 modifier for Non-Medicare patients.
Hope this helps!