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Reminder about Preventive Screening Colonoscopies

Blue Cross and Blue Shield of North Carolina (BCBSNC) offers colonoscopy testing as a covered service for our commercial members with preventive care benefits. A member's actual benefit for colonoscopy testing can vary depending on the member's specific benefits, the place of service where the service is performed, and the diagnosis code submitted on the claim.

If you provide screening colonoscopy services to a BCBSNC member (i.e., a patient who is asymptomatic, but due for a screening based on U.S. Preventive Services Task Force guidelines), a primary diagnosis code indicating that it is a screening exam (e.g. V76.51) should be used to ensure that your patient receives the appropriate preventive care benefit. Even if the colonoscopy reveals polyps when performed, the screening exam code V76.51 should be reported as the principle diagnosis when submitting the claim to BCBSNC. The diagnosis code for polyps should be listed as a secondary diagnosis code on the same claim.

Please note that these instructions for filing colonoscopy screening exam code V76.51 only apply when the exam is ordered as a preventive screening for an otherwise healthy individual. CPT code V76.51 is not appropriate to use when billing for colonoscopy diagnostic testing performed to diagnose or treat a specific condition.

Always verify a patient's BCBSNC benefits and eligibility in advance of providing scheduled services.