Gastroenterology Coding Alert

Question: A 65-year-old established Medicare patient with regional enteritis and a family history of gastrointestinal cancer reports to the gastroenterologist for a scheduled Medicare colonoscopy screening for colorectal cancer. The patient's medical record indicates that he has never received a covered screening from our gastroenterologist; however, a gastroenterologist at a different practice performed a screening colonoscopy on the patient in March 2006. Is this patient eligible for another covered screening? Florida Subscriber Answer: The patient's enteritis and family history of cancer put him at high risk for colorectal cancer, meaning he is eligible for a covered screen as often as every 24 months depending upon the individual clinical  circumstances. On the claim, you'll likely report G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) for the screening. According to the local coverage determination (LCD) for First Coast Service Options Inc., a Florida Medicare payer: "Screening colonoscopies (code G0105) are [...]