8/19/2019 Keep Your Screening Colonoscopy on Track With These
Tips
2/3
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713,
Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
[email protected]
Medicare patients is that they come without “cost sharing” by
the patient — which means the patient is
responsible for no copay or deductible cost for the colonoscopy
procedure itself.
Whether a procedure is considered to be screening for Medicare’s
purposes depends on the situation of
the person having the test, not on the results or findings of
the test. For this reason, a screening
colonoscopy is defined as a procedure that is routinely
performed on an asymptomatic person to
determine whether colon cancer or polyps are present.
For screening colonoscopy procedures for Medicare patients,
report the appropriate screening HCPCS G
code, such as G0105 (Colorectal cancer screening; colonoscopy on
individual at high risk) and G0121
(Colorectal cancer screening; colonoscopy on individual not
meeting criteria for high risk).
When is a Screening Not a Screening?
But what if during the screening procedure, the
gastroenterologist finds and removes a polyp, or decides
she needs to biopsy a suspicious-appearing patch of colonic
mucosa? It gets tricky for Medicare claims
when there’s a finding on a screening colonoscopy that requires
biopsy or excision. In these cases, while
the diagnosis is still a screening one, since that was the
reason for the procedure in the first place, the
procedure itself is no longer considered a screening.
When a colonoscopy on a Medicare patient suddenly switches from
screening to needing a biopsy or
polypectomy, you can’t report the procedure with a G code.
Instead, you’ll need a CPT® code such as
45380 (Colonoscopy, flexible; with biopsy, single or
multiple).
Don’t ZZZ Off on the Z Code With Screening Colonoscopy
Don’t f orget the diagnosis code! Medicare makes it clear
that if a patient presents for a screening
colonoscopy, you must report an ICD-10-CM Z code such as Z12.11
(Encounter for screening for
malignant neoplasm of colon; Encounter for screening colonoscopy
NOS) as the primary diagnosis in Box
21 of the CMS-1500 claim form. That’s the case even if you can’t
report a screening procedure because a
biopsy or polypectomy was needed.
If your provider did perform a polypectomy, turning the
screening procedure into a therapeutic one,
you’ll want to make sure you adequately describe the medical
necessity for the removal by reporting an
appropriate polyp diagnosis code (D12.-, Benign neoplasm of
colon, rectum, anus and anal canal) in
addition to the screening code. (You’d report an appropriate
diagnosis code for a biopsy, also.) To make
the proper choice among the D12.- codes, your documentation must
specify the polyp’s location, such
as anus, rectum, sigmoid, descending, etc.
Got GI Endoscopy Coding Tips?
Have you had particular success with certain scenarios of GI
endoscopy coding? Let us know. We love to
hear from you!
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]
8/19/2019 Keep Your Screening Colonoscopy on Track With These
Tips
3/3
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713,
Eenterprise Contact: Sam Nair, Direct: 704 303 8150,
[email protected]
Gastroenterology Coder Puts You in the Speed-Coding Driver’s
Seat!
Gastroenterology Coder cuts your code search time by letting you
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codes all at once. You also get one-click access to local
coverage determinations (LCDs), national
coverage determinations (NCDs), medically unlikely edits (MUEs),
the Correct Coding Initiative (CCI)
edits checker, and more. Contact us today for demo and free
trial access!
Enterprise Contact Person:
Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: [email protected]
Direct: 704 303 8150
Desk: 866 228 9252, Ext: 4813
The Coding Institute LLC, 2222 Sedwick Road, Durham, NC
27713
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]
