Tag Archives: 45378
Posted on 09. Dec, 2010 by jennifer.godreau.
Question: I’m receiving contradictory guidance on which modifier to use when a gastroenterologist does an incomplete colonoscopy. Should I use modifier 52 or 53?
Answer: CPT 2011 ends the days of arguing over whether to use modifier 52 or 53 for an incomplete colonoscopy. If the gastroenterologist could not get beyond the splenic flexure for reasons including poor prep, he is supposed to report 45378 with modifier 52, according to CPT 2010. CMS policy, however,
Posted on 26. May, 2010 by Editor.
Getting Medicare to pony up for colorectal cancer screenings is not difficult provided you follow its frequency guidelines and eligibility requirements to the letter. A coding slip up on one of these items will knock you out of the saddle, and Medicare won’t accept the claim at all.
Rope in all the coding info you’ll need via this Medicare colorectal cancer screening FAQ.
Who’s Eligible for Average-Risk Test?
If the Medicare patient is 50-plus years old, he is eligible for a covered Medicare screening, confirms Dena Rumisek, CPC, biller at Michigan’s Grand River Gastroenterology PC.
Posted on 12. Apr, 2010 by Editor.
If you slip up on screening colonoscopy claims’ frequency guidelines and eligibility requirements, Medicare will pay you zilch.
Use this guidance to capture every screening dollar your gastroenterologist deserves.
Home in on Eligibility Requirements for Average-Risk Test
Posted on 03. Feb, 2010 by .
Question: A local family physician refers a patient to our gastroenterologist for a diagnostic colonoscopy. The patient reports to the practice and meets the gastroenterologist for the first time. After answering some patient questions during a brief introduction, the gastroenterologist performs a diagnostic colonoscopy with brushing. The patient had never met the gastroenterologist before. Is the time he spent with the patient pre-screening a separate E/M?
Answer: Do not report a separate E/M for this encounter. On the claim, report 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression [separate procedure]) for the service.
Posted on 04. Sep, 2009 by .
If you slip up on screening colonoscopy claims’ frequency guidelines and eligibility requirements, Medicare will pay you zilch. But our colorectal cancer screening FAQ provides you the coding the know-how you need to soar through your coding duties with the greatest of ease.
Q: Who’s Eligible for Average-Risk Test?
Any Medicare patient 50 years or older is eligible for a covered Medicare screening, confirms Dena Rumisek, CPC, biller at Michigan’s Grand River Gastroenterology PC.
Catch: These patients can have a colorectal cancer screening only once every 10 years, says Cheryl Ray, CCS, CPMA, of Atlantic Gastroenterology in Greenville, N.C. You’d be wise to pay attention to the frequency guidelines, as “Medicare is very stringent on the date … it has to be 10 years or longer — it can’t be 9 years and 360 days” between covered screening colonoscopies, assures Rumisek.
Example: A 73-year-old established Medicare patient reports for a screening colonoscopy on Aug. 11, 2009. The patient’s records indicate that he last had a covered screening on July 31, 1995. On the claim, you should report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).
Posted on 17. Mar, 2009 by .
Are you sure you’re capturing every dollar your physicians deserve when they perform multiple scope procedures in one surgical session? There are times when you can report multiple scope procedures together, but if you don’t know what they are you could be leaving money on the table.
Check Parent Codes Before Billing Multiple Scopes
Colonoscopies, small bowel endoscopies, and anoscopies are all endoscopic procedures. The first question you need to ask when coding multiple endoscopic procedures during the same surgical session is: Are the endoscopies the surgeon performed in the same code “family”?
Pointer: If the answer is yes, the multiple-scope rule specifies that you cannot report the base, or “parent,” code separately with a more extensive endoscopy in that same code family.
Posted on 24. Feb, 2009 by .
Hint: You’ll notice that many of the esophagoscopy, EGD, and enteroscopy codes contain the same CPT descriptions. The difference is the distance your GI travels through the patient’s upper GI tract. Be sure to verify that detail in your documentation.