A Non-Medicare patient presents for a screening colonoscopy due to a polyp that was removed X years ago. The patient currently has no signs or symptoms. This patient has a high risk determination (history of colon polyps, denoted by HCPCS code V12.72) so the procedure would be scheduled as a screening colonoscopy on an individual at high risk (HCPCS G0105). During the screening exam, the physician discovers a polyp in the colon and removes it with a snare technique. Based on the definition of and requirements for modifier -33, the correct code assignment for this scenario is 45385-33. The claims processing system should read this as the initial procedure was expected to be a screening colonoscopy but a polyp was identified and removed in the same encounter.
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