Gastroenterology Coding Alert

Question: A Medicare patient has a family history of colon cancer. Five years ago, the patient underwent a colonoscopy screening and our physician performed another one recently. Medicare will not pay for the most recent screening. The patient had no symptoms, but we thought that Medicare would pay if the patient was high risk. We have tried codes 45378 and G0121. Maryland Subscriber Answer: The correct procedure code is G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) and the primary diagnosis should be V16.0 (Family history of malignant neoplasm; gastrointestinal tract). The code G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk) is for patients who are not high risk, and Medicare will only pay for such a screening once every 10 years. Check to see how that colonoscopy screening was submitted five years ago. If it was coded G0105, and you resubmit the [...]