ACG: 7 GI/endoscopy coding & billing tips for screening colonoscopy

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.

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