Message for Providers Performing Preventive Screening Colonoscopies
Blue Cross and Blue Shield of North Carolina (BCBSNC) offers colonoscopy testing as a covered preventive-benefit for our members. Member's benefits for colonoscopy testing can vary depending on a member's specific benefit package, the location (place of service) where the service is performed, and the reason/diagnosis a colonoscopy is ordered.
If you are a provider of colonoscopy services and are seeing a BCBSNC member for a colonoscopy that was ordered as a screening exam (i.e. on a patient who is asymptomatic, and due for a screening based on USPSTF guidelines [U.S. Preventive Services Task Force]), the exam should be billed with a primary diagnosis code as a screening exam (e.g. V76.51) to help ensure your patient will receive their 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 a claim to BCBSNC. The diagnosis code for polyps should then be listed as a secondary diagnosis code on the same claim for that member.
Please note that these instructions for filing screening exam code V76.51 for colonoscopy services apply only when the examination has been ordered as a preventive screening for an otherwise healthy individual. Code V76.51 is not considered appropriate when billing for colonoscopy diagnostic testing performed to diagnose or treat a condition.
Providers are reminded to always verify a patient's BCBSNC coverage and eligibility in advance of providing scheduled services.