Gastroenterology Coding Alert

Question: How should we report a finding of hemorrhoids during a screening colonoscopy? Would the -screening- become -diagnostic- in this case?


Michigan Subscriber


Answer: If the gastroenterologist finds hemorrhoids during a screening, you-re better off sticking with G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) or G0121 (... colonoscopy on individual not meeting criteria for high risk) rather than trying to code for a diagnostic procedure.

Hemorrhoids are not a covered diagnosis for any of the codes in the colonoscopy family (45378-45387), so diagnostic reimbursement is unlikely.

In contrast, however, if the gastro performs a screening on an average-risk patient but finds and removes two polyps, you shouldn't report G0121. Instead, you should report the diagnostic colonoscopy code for polyp removal. Specifically, you would submit 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesions[s] by snare technique).

You should also report an ICD-9 code to represent the polyps found in the colon (211.3 for colonic polyps). Medicare guidelines stipulate that you should also report a secondary diagnosis of V76.51 (Special screening for malignant neoplasms; colon) to show that the polyps were discovered during what began as a screening.

Learn more: See -Do Polyps Make a Screening Diagnostic? CMS Clarifies- later in this issue for more information on diagnostic-versus-screening colonoscopy and how to apply ICD-9 and CPT codes correctly for procedures of this type.