Advance for Health Information Professionals:Coding Colonoscopies

What is the proper way to code a colonoscopy?  That’s the question AAPC member Donna SanGiovanni, CPC, CASCC, CHI, talked about in a recent article feature in Advance for Health Information Professionals. “The diagnosis code for the screening is selected from the V code section V76.51 (Special screening for malignant neoplasms, colon). The CPT code would be 45378 (Colonoscopy, flexible, proximal to splenic flexure, diagnostic),” says SanGiovanni.

The article is available online by clicking here.

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10 Responses to “Advance for Health Information Professionals:Coding Colonoscopies”

  1. Gwendolyn Darrrell says:

    The patient had a colonoscopy 6 years ago. Past medical history indicates mother had colon cancer at age 35. The patient comes in with family history of colon cancer. A colonoscopy is performed. The colonoscopy is normal. The colonoscopy report has the following indication for the procedure: Screening for family history of colorectal cancer (V16.0) including the mother. Findings are normal. CPT code is 45378.
    I would be interested in how one would code this.
    ICD-9 code: ____________________
    CPT code: 45378

  2. Eva says:

    I would code V76.51 w/v160

  3. Lisa says:

    I would code this colonoscopy as 45378 with V16.0. Pt is considered high risk and had an initial colonoscopy 6 years ago. If she was an average risk patient, she would not be due for 10 years. High risk patients are allowed surveillance colonoscopies every two years per Medicare guidelines.

  4. Sylvia says:

    I would have coded this as G0105 V16.0

  5. lgonsows says:

    It is my understanding that if a patient seen in the office complaining of rectal bleeding and doc suggests a screening colonoscopy that is actually not a screening because pt has GI symptoms. Therefore I would bill a diagnostic colonoscopy. Am I correct?

  6. Valerie Borders says:

    I would code V16.0 45378. The patient does not currently have cancer .

  7. Jen says:

    I would code it V16.0 and G0105.

  8. Helen says:

    what if the pt has v16.0 and 211.3. the doctor did both g0105 and 45380. will medicare/commercial insurance pay for both procedure? is it recommended to bill both cpt?

  9. Paphanij says:

    According to ICD-10-CM, I would code this case with 45378 and Z80.0 for family history of cancer of the colon. ICD-1-CM, code Z80.0 represents family history of malignant neoplasm of digestive organs.

  10. Paphanij says:

    Oops! I had a typo on my last post. It’s ICD-10-CM.

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