Confusion surrounding coding and billing can result in denied claims and delayed payment. Here are seven tips for coding screening colonoscopies, according to the American College of Gastroenterology.
• Screening is performed on a patient with an absence of signs and symptoms.
• Medicare defines average risk as no personal or family history of adenomatous polyps, colorectal cancer or inflammatory bowel disease.
• Most payers set patient eligibility for screening colonoscopy at or after age 50.
• Since Jan. 1, 2011, Medicare waives co-pays and deductibles for the professional and facility fees for screening colonoscopy.
• In Medicare's final rule for 2015, Medicare expanded its co-pay and deductible waiver to include anesthesia for screening colonoscopy. A -33 modifier should be added to the 00810 anesthesia code to indicate the circumstance was preventive, according to the report.
• Medicare allows follow-up procedures every 10 years if the screening colonoscopy is negative.
• Billing for an average risk screening patient includes G0121 (Medicare), and commercial, Medicaid, exchange/marketplace, Tricare: 45378 with the appropriate ICD-9 (through Sept. 30) or ICD-10 code (effective Oct. 1) for screening.