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V76.51 and 99203

Maarit Posted Fri 03rd of February, 2012 17:28:10 PM

May we bill for the initial consult for a PT who comes for a screening colonoscopy without any symptoms? There seems to be a lot of confusion about this.

According to BCBS bulletin in April the new modifiers 99203 -33 for comercial ins, and 99203 -PT for Medicare are to be used for this initial preventive visit.

However, some other sources say these modifiers are to be used on the colonoscopy CPT when the screening procedure turns into diagnostic (45378 turns into 45380 or 45385)
Please clarify this to me.

SuperCoder Answered Fri 03rd of February, 2012 17:48:14 PM

That was not mentioned in your earlier posts that the patient came for Screening purpose. I am submitting the complete guidelines relating to this:
************************************
Centers for Medicare & Medicaid Services to clarify billing instructions for the Medicare beneficiary who
1) presents for a screening colonoscopy (or flexible sigmoidoscopy),
2) has no gastrointestinal symptoms, and
3) during their screening colonoscopy (or flexible sigmoidoscopy), have an abnormality identified (such as a polyp, etc.) which is biopsied or removed.

If a polyp is found, the above scenario should be billed as follows:
Primary Dx: V76.51 (Special screening for malignant neoplasms, Colon)
Secondary Dx: 211.3 (Benign neoplasm of other parts of digestive system, Colon).

================================================================================
Therapeutic colonoscopy
***********************
When signs and symptoms are related to the GI tract (i.e., abdominal pain, blood in stool, chronic diarrhea, change in bowel habits, weight loss or blood loss anemia), the above mentioned V-code (V76.51) should never be assigned. A symptom code should be assigned when there is no definitive diagnosis. If the patient's history notes a family history or personal history of colonic malignancy or polyps, the appropriate V-code from the box above should be assigned as a secondary code.
*

CPT codes 45380-45385 are used to report procedures through the colonoscope. Therapeutic colonoscopies include a diagnostic component; code 45378 is not reported with the services below.
*

When the above procedures are performed for a Medicare patient who originated as a screening colonoscopy, the HCPCS G-code should not be reported. CPT 45378 should not be reported with 45308-45385.
*

Modifiers -33 and -PT :Assign modifier- 33 to non-Medicare therapeutic procedures and modifier -PT to Medicare therapeutic procedures.

==============================================
Modifier 33 “Delineated Preventive Service” is used to indicate that a specific preventive service should be a payable service and not another type of preventive service that is typically not paid by insurers. Types of services that might have a modifier 33 include the following:
***
•For Medicare IPPE (welcome to Medicare), initial and subsequent wellness encounters
•Well woman exam (screening breast and pelvic exam for Medicare)
•Well baby or well child encounters
•Annual physical exam for some commercial payers and Medicaid

***

Types of preventive services that would not have this modifier include the following:

•Travel physical
•Sports exam
•School physical
•Employment exam

Maarit Posted Fri 03rd of February, 2012 20:34:46 PM

My question still remains: should we bill for the initial consult of a screening colonoscopy as 99203 -33 and 99203 -pt depending on carrier. Your examples (below) did not include this scenario.

Modifier 33 “Delineated Preventive Service” is used to indicate that a specific preventive service should be a payable service and not another type of preventive service that is typically not paid by insurers. Types of services that might have a modifier 33 include the following:
***
•For Medicare IPPE (welcome to Medicare), initial and subsequent wellness encounters
•Well woman exam (screening breast and pelvic exam for Medicare)
•Well baby or well child encounters
•Annual physical exam for some commercial payers and Medicaid

***

Types of preventive services that would not have this modifier include the following:

•Travel physical
•Sports exam
•School physical
•Employment exam

SuperCoder Answered Sat 04th of February, 2012 02:45:18 AM

You are right in pointing out this. So, the relevant article is here:
http://www.supercoder.com/articles/articles-alerts/mob/cpt-2012-primer-rejoice-the-addition-of-a-new-flu-vaccine-code-new-preventive-services-modifier-108836/

Maarit Posted Mon 06th of February, 2012 21:46:48 PM

I'm sorry. I do not have access to that article. Is there a simple answer?

SuperCoder Answered Tue 07th of February, 2012 15:44:34 PM

In the link above it is written that,
"....code 99213 would require modifier 33 when the provider indicates that the service was preventive...." This seems to suffice that for BCBS, you can also use modifier 33 with new pt visit 99203 if the the service is found to be preventive.

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