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Medicare Screening Colonoscopy with Hehmorrhoid findings

Suhel Posted Wed 08th of June, 2016 15:16:25 PM
I understand the differences among 45378, G0105 and G0121 for Medicare patients who have had a screening colonoscopy. The example provided in SuperCoder's publication dated 1/27/2004 titled "COLONOSCOPIES: 3 EXAMPLES CLARIFY DIFFERENCE BETWEEN SCREENING AND DIAGNOSTIC", refers to "incidental findings of diverticuli" only: "1.) A patient who comes in asymptomatic & not at high risk for colorectal cancer - during the colonoscopy, the physician makes an incidental finding that the patient has diverticuli. You should still bill this as G0121." My question is if the physician makes an incidental finding of HEMORRHOIDS, would you still use G0121 or would it now change to 45378? My scenario: Non-high risk 68 yr old patient came in for screening colonoscopy. Doctor's services codes on operative report are Z12.11 screening and K64.0. Please advise...and thank you for your assistance in advance. ~Annette
SuperCoder Answered Thu 09th of June, 2016 02:21:21 AM
Hi, In the scenario mentioned, due to the incidental finding of Hemorrhoids, the screening colonoscopy turned into diagnostic procedure and should be reported with appropriate diagnostic colonoscopy code (45378 as you mentioned). Also, as per Medicare one needs to append modifier PT to the code to indicate that the procedure began as a screening test. Medicare will still waive the deductible, but the patient has to bear the coinsurance. Please refer to this link, as it will provide an insight to the scenario. Hope this helps. Thanks

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