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SuperCoder Posted Mon 29th of December, 2014 17:20:46 PM

Medicare patient. Colonoscopy was performed on patient with a V18.51. The physician did a BX on the patient. I coded the claim with V18.51 as primary 569.0 as the secondary and CPT code 45380 with the PT modifier. Medicare denied as the V18.51 was not covered? Has Cahabla Medicare taken V18.51 off as a diagnosis for a high risk patient? Thanks

SuperCoder Answered Wed 31st of December, 2014 00:03:57 AM

We are researching on it and will get back to you ASAP. Thanks !!

SuperCoder Answered Wed 31st of December, 2014 00:03:57 AM
SuperCoder Answered Fri 02nd of January, 2015 09:16:25 AM

Thanks for your patience. V18.51; Family history, colonic polyps is not a covered diagnosis code for 45380; Colonoscopy, flexible; with biopsy, single or multiple. According to Cahaba's LCD, the only V code for colon polyps that is covered is for personal history of colon polyps, V12.72. Cahaba will cover V18.51 for the high risk G codes. Hope this helps.

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