Internal Medicine Coding Alert
Look to Screening LCDs for High-Risk Clues
PDF
Watch out: Medicare carriers may differ on some ICD-9 codes
Why? All Medicare carriers will have a set list of diagnoses that they will accept when you report G0105 (Colorectal cancer screening; colonoscopy on individual at high risk).
The problem is the lists might not be consistent from carrier to carrier.
Solve the Problem Easily
No sweat: All you have to do is contact your local Medicare carrier, or check out its local coverage determination (LCD), and you'll be able to find out what conditions your payer allows for G0105.
Also, check out this partial list of ICD-9 codes that prove a patient is at high risk for colorectal cancer from Wheatlands Administrative Services (a Medicare carrier for Kansas, Nebraska and parts of Missouri). Check your local carrier for a similar list.
• V10.05 -- Personal history of malignant neoplasm; large intestine
• V10.06 -- ... rectum, rectosigmoid junction and anus
• V12.72 -- Personal history of certain other diseases; colonic polyps
• V16.0 -- Family history of malignant neoplasm; gastrointestinal tract• 555.1 -- Regional enteritis; large intestine
• 555.2 -- ... small intestine with large intestine
• 555.9 -- ... unspecified site
• 556.0, 556.1 556.4, 556.5, 556.6, 556.8, 556.9 -- Ulcerative colitis
• 558.2 -- Toxic gastroenteritis and colitis
• 558.9 -- Other and unspecified noninfectious gastroenteritis and colitis.
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