Well, you should have determined the advantages of the procedure and verified the payment prior to performing it on the patient. Colonoscopy procedures in patients minus active symptoms don't qualify as an emergency and the best way to ensure that the physician is paid for the service is to get phone verification of benefits. What's more, regulation does not require insurance coverage for high-risk screening colonoscopy.
Even though some insurance would accept G0105 Colorectal cancer screening; colonoscopy on individual at high risk) in place of 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]) to qualify for screening benefits, you should not bill it unless the insurance company representative instructed it during the verification process. Commercial carriers for non-Medicare patients normally do not recognize G0105, which is a CMS code.
Intent: G0105 is a CMS HCPCS code that applies for screening of a patient that has a high-risk for colorectal neoplasia. Examples would be universal ulcerative colitis (556.6) or a history of malignant neoplasm of the lower gastrointestinal tract (V10.0). When the service reveals no findings, you should report this HCPCS code(Source "").
No modifier would be proper to use on 45378 if you insist on using this code. Nevertheless, you could try sending all notes with your claim. If the patient was referred for the procedure, you might want to ask the referring physician if she would write a letter validating medical necessity.
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