Please read below different scenarios to bill colonoscopy screening as per diagnosis, incidental finding and no finding.
If it states regular screening, G-code comes to mind. G0121 for regular screen. G0105 for high risk or increased risks such as Z85.038, Z86.010, Z80.0 and Z38.79. If there are any indications of R10.9 or R10.xx, R19.7, K52.29 etc, and nothing is found, I consider these as incidental signs and symptoms and use the screening codes when also indicated. If only the incidental s/s are mentioned, I use 453XX.
Now, if s/s such as K59.00, K62.5, K19.5, which are real indications of a problem, and screening is also listed as indication, I will not use G code. This is a diagnostic procedure billed with 453XX or depending whether physician finds polyp, and remove or bx it, 4538X.
If your pt comes for a screening, regular or high risk, and bx or polypectomy is performed, you would still use the Z code as primary dx and the polyp as 2nd, since this was the original intend. Append modifier Pt or 33 whatever is appropriate for the carrier you billed.
Also, in more simpler way with some examples see below:
If the surgeon performs a diagnostic colonoscopy for a Medicare beneficiary, you should report the appropriate CPT code that describes procedure, such as 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen[s] by brushing or washing, when performed [separate procedure]).
But you should report screening colonoscopies for Medicare beneficiaries using one of the following codes:
- G0105 (Colorectal cancer screening; colonoscopy on individual at high risk)
- G0121 ( Colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk)
For non-Medicare payers, you’ll report a screening or diagnostic colonoscopy that involves no further intervention using 45378.
Whether for Medicare or non-Medicare payers, if the surgeon finds something during the colonoscopy that results in further intervention, you should use the appropriate CPT code, such as one of the following:
- 45380 (Colonoscopy, flexible; with biopsy, single or multiple)
- 45384 ( Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps)
Please feel free to ask for any further query.