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To: luckystarmom
a screening colonoscopy and a polypectomy are two completely different CPT codes...

Screening Procedure Information for Colonoscopy and Endoscopy

If your colonoscopy has been scheduled as a screening colonoscopy (meaning you have no symptoms with your bowels), and your doctor finds a polyp or tissue that has to be removed during the procedure, this procedure is no longer considered a screening procedure, it is considered a surgical procedure and your insurance benefits may change. Please check with your insurance carrier prior to starting the bowel preparation. Symptoms such as change in bowel habits, diarrhea, constipation, bleeding and anemia constitute bowel symptoms.


Screening CPT codes 45378, G0105, G0121
Colonoscopy with biopsy 45380
Colonoscopy with polypectomy 45385 usual diagnosis code 211.3 or 211.4

If your upper endoscopy has been scheduled as a screening procedure (meaning you have no symptoms with your stomach), and your doctor finds any polyps or tissue that needs to be biopsied, the procedure is no longer considered a screening procedure, it is considered a surgical procedure and your insurance benefits may change. Please check with your insurance carrier prior to the procedure for detailed information.


Screening CPT codes 43235
Upper endoscopy with biopsy 43239
Upper endoscopy with polypectomy 43251

like i said count you blessings...

by the way, who is your insurance carrier?


56 posted on 04/14/2014 9:14:22 PM PDT by Chode (Stand UP and Be Counted, or line up and be numbered - *DTOM* -vvv- NO Pity for the LAZY - 86-44)
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To: Chode

Blue Shield of California PPO. I’ll ask my husband about why it was covered.


58 posted on 04/14/2014 9:28:57 PM PDT by luckystarmom
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To: Chode

Here’s a link that says polyp removal is covered:

https://www.blueshieldca.com/bsca/documents/about-blue-shield/health-reform/A45296_2-13.pdf


59 posted on 04/14/2014 9:32:20 PM PDT by luckystarmom
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