Recent content by lamiller

  1. lamiller

    Wiki Modifier PT/XS

    I have been getting denials for 45385-PT and 45380-XS from BlueCross Medicare Advantage saying they are bundled. I have done reconsiderations and appeals with no luck. I attended a Gastro Seminar a few months ago and spoke to another Gastro Office in Tennessee that was getting paid for both...
  2. lamiller

    Wiki Modifier PT/33

    If this a Medicare plan then yes, PT on 45385 and XS on 45380. I have been getting denials though for BlueCross Medicare Advantage in Tennessee with 45380-XS saying it's bundled.
  3. lamiller

    Wiki Colonoscopy after a positive stool test.

    I agree....I have gotten this update as well. If the screening colonoscopy followed by positive stool based test becomes diagnostic I believe I would treat it as any regular screening DX codes. No need to put in the R19.5 anywhere, correct?? Now, just to get our providers to put the...
  4. lamiller

    Wiki Colonoscopy after a positive stool test.

    Was there anything mentioned about coverage before May 21, 2022 not being covered for commercial and Medicare patient's?
  5. lamiller

    Wiki Colonoscopy after a positive stool test.

    What are thoughts on coding it like R195, Z12.11 G0121. I guess it's worth a try to see if they will pay? My providers are asking how we will get paid for this of course, all I can tell them is I'm researching it still and there is no guidance on how to bill it. I even attended a Gastro...
  6. lamiller

    Wiki Medicare diagnostic colonoscopy with biopsy

    When billing for Medicare and it's a screening turned into diagnostic I will usually code it with DX finding (EX cecum benign adenoma, D12.0) followed by Z12.11. CPT would either by 45385 for snare biopsy or 45380 for cold forceps with the PT modifier. I hope this helps.
  7. lamiller

    Wiki RN Patient Teaching CPT

    I work in a Gastro and we have an RN that we want to start doing some patient teaching with our UC and Crohn's patients, maybe others as well. Is there a CPT code and DX code we need to use? Is this even allowed by an RN?
  8. lamiller

    Wiki Colonoscopy after a positive stool test.

    Thank you for this information. So Medicare will also be covering this now? Do you happen to have the link for the article?
  9. lamiller

    Wiki Colonoscopy after a positive stool test.

    Has anyone found any updates on this so we know how to bill for it?
  10. lamiller

    Wiki Positive Cologuard

    Can someone clarify this for me? We are having a discussion with our providers over this and need to know what to tell them? If a patient has a positive cologuard test how do I then code it as a screening? Do I code Z12.11 then R19.5? I know there is certain eligibility rules in place as far...
  11. lamiller

    Wiki CPT 88312

    I have gotten several denial lately from Cigna Medicare Advantage. I called today and was told this CPT is not payable because of LCD? I've never heard of that before. Is anybody having trouble with the same issue? TIA
  12. lamiller

    Wiki Colonoscopy after a positive stool test.

    Can someone tell me how this would be coded? Z12.11 followed by R19.5 and any findings? Also, just so I am understanding that any policies prior to May 31,2022 will not cover this? Thanks for the help
  13. lamiller

    Wiki CPT 43249 and 43239

    Can someone tell me why I am not getting paid for both 43249 and 43239-XS with Blue Cross Medicare Advantage plans? 43249 was billed with DX code K22.2 and 43239-XS was billed with K31.89 and R13.19. I thought these were not bundled together. Thanks in advance for any help
  14. lamiller

    Wiki CPT 45385 and 45380 Together

    I am getting tons of denials from BCBS Medicare Advantage in Tennessee with 45385 and 45380 billed together. I have use 59 and XS modifiers and still denied. The denial code is C045 and some C0131. Does anybody have any thoughts on this??? Thanks for the help in advance.
  15. lamiller

    Wiki Denials CPT 45385 with 45380

    We were getting paid using modifier 59 on 45380 and then they stopped paying. I just can't seem to get a straight answer on our Representative about this. I don't want to write off the 45380 if they will pay somehow.
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