Do you use modifier 33 for surveillance colonoscopy?
Asked by: Ms. Kirstin O'Connell | Last update: February 17, 2025Score: 4.3/5 (6 votes)
How to bill surveillance colonoscopy?
To report a screening colonoscopy on a patient not considered high risk for colorectal cancer, use HCPCS code G0121 and diagnosis code Z12. 11 (encounter for screening for malignant neoplasm of the colon).
Is surveillance colonoscopy the same as screening colonoscopy?
Diagnostic colonoscopies, also referred to as follow-up or surveillance colonoscopies, are different from screening colonoscopies since such procedures are provided when there is a greater probability of cancer development or if there is evidence that colorectal cancer might be present.
What is the ICD 10 code for surveillance colonoscopy?
Encounter for screening for malignant neoplasm of colon
Z12. 11 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2025 edition of ICD-10-CM Z12. 11 became effective on October 1, 2024.
What are the guidelines for colonoscopy screening and surveillance?
- Colonoscopy every 10 years.
- CT colonography (virtual colonoscopy) every 5 years.
- Sigmoidoscopy every 5 years.
Preventive vs Diagnostic Colonoscopy for Outpatient Hospital
What are the nice guidelines for surveillance colonoscopy?
Surveillance can be stratified by risk: • low: consider colonoscopy at 5 years, • intermediate: offer colonoscopy at 3 years, • high: offer colonoscopy at 1 year. Other tests, e.g. computed tomographic colonography (CTC) or double contrast barium enema, should be offered if indicated.
Does Medicare pay for surveillance colonoscopy?
Colonoscopies. Medicare covers screening colonoscopies once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy. There's no minimum age requirement.
When to use modifier 33?
Modifier 33 should be used when the primary purpose of the service is the delivery of an evidence-based service in accordance with the guidelines provided by one of the ACA-designated organizations, including an A or B recommendation from the USPSTF.
Do you use Z12-11 on surveillance colonoscopy?
If a patient has had previous removal of colon polyps a few years ago and is now presenting for surveillance colonoscopy to look for any additional polyps or recurrence of the polyp this is coded with Z12. 11, Encounter for screening for malignant neoplasm of colon as the first listed code.
What is the KX modifier for colonoscopy?
Modifier KX was published in Medicare's Med-Learn Matters Article, MM13017, addressing modifier KX. Medicare indicates the following: "Attach the KX modifier to a screening colonoscopy code to indicate such service was performed as a follow-up screening after a positive result from a stool-based test.”
What is the difference between surveillance and screening?
The fundamental purpose of screening is early diagnosis and treatment of the individual and thus has a clinical focus. The fundamental purpose of surveillance is to detect and eliminate the underlying causes such as hazards or exposures of any discovered trends and thus has a prevention focus.
How much is a surveillance colonoscopy?
Without insurance, a colonoscopy in the U.S. can range from $1,250 to $4,800 or more with an average cost of $2,750. If you have insurance, you typically pay nothing for a screening colonoscopy.
What is the PT modifier on a colonoscopy?
The –PT modifier indicates a screening colonoscopy has been converted to a diagnostic test or other procedure.
Is a surveillance colonoscopy diagnostic or screening?
Diagnostic colonoscopies, also known as follow-up or surveillance colonoscopies, are different from screening colonoscopies, as they are performed when there is a greater chance that cancer might develop or in the event there are indications that colon or rectal cancer may exist.
What is the modifier 22 for a colonoscopy?
When the colonoscopy procedure is unusual or difficult, modifier 22 (unusual procedural services) may be reported. The most specific ICD-10-CM code must be chosen and billed to its highest level of specificity. Submit this as the line diagnosis (linked to the procedure) on the claim.
What is the modifier 52 for colonoscopy?
Therapeutic colonoscopies that are incomplete (the scope does not reach the cecum during a therapeutic procedure) are reported with modifier 52. It is important to note that the codes for reporting these procedures differ between Medicare and other payors.
What is the difference between Z12 31 and Z12 39?
The Z12. 31 is specific to screening mammograms and the Z12. 39 is any screening of the breast other than mammograms.
When coding a colonoscopy, what modifier is used to indicate a discontinued procedure?
Modifier “-53” (discontinued procedure) must be appended to any procedure code submitted when billing for a failed colonoscopy attempt.
What is the modifier 33 with 99497?
Advance care planning is a preventive service only when provided in conjunction with an annual wellness visit and reported with modifier 33 attached to the advance care planning code (e.g., 99497-33).
How do you know if a code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
What is CPT 96127 with modifier 33?
When a primary care physician uses a standardized screening tool to evaluate the patient for depression, you may report CPT 96127 with a modifier 33 to signal the payer that it is being billed as a preventive service.
What is the 33 modifier for colonoscopy?
Add modifier 33 (preventive services) to each CPT code submitted on the claim. If modifier 33 is not added, the colonoscopy will not be recognized as a screening service and the patient will be inappropriately billed.
When can you stop colonoscopy surveillance?
The American College of Physicians, e.g., recommends that average-risk CRC screening be discontinued in patients with a life expectancy of <10 years (the average life expectancy for a 75-year-old in the United States) (11).
What is the difference between PT and 33 modifier?
While modifier PT is specific to colorectal screenings converted to diagnostic or therapeutic services, modifier 33 broadly applies to any ACA-designated preventive service with a commercial payer.