45378 vs. G0105

[rcclary]

If a Medicare patient has a colonoscopy with the reason for exam being V12.72 and the findings are angioestasia (569.84) and internal hemorrhoids (455.0) would you still use G0105 or 45378?

 

[MRandles]

pt presented for a high risk screening so I would use G0105

 

[kbarron]

G0105 is screening for pt that has ulcerative enteritis or a hx of malig neoplasm of the lwr gastrointestinal tract. We are having a similar situation where one of my co workers says to use G codes for all Medicare colonoscopies. The HCPCS states refer to CPT codes book for possible alternative codes. :

 

[elenax]

It is my understanding that the 'G' codes is used strictly for screening and that if there is any finding in the process of doing the colonoscopy you should use the CPT code 453XX. Any other feedback

 

[coachlang3]

To my knowledge, you only use the G code if there are no findings. If the pt came in as a screening though, you would put the V code as a dx code in the first slot to show it was a screening that converted.

example:

pt comes in for a high risk screening might look like this: CPT G0105
DX V12.72

pt comes in for a high risk screening but there are findings: CPT 45380
DX1 V76.51
DX2 211.3

of course I just put in generic numbers, but thats the gist of it.

 

[Lisa Bledsoe]

To my knowledge, you only use the G code if there are no findings. If the pt came in as a screening though, you would put the V code as a dx code in the first slot to show it was a screening that converted.

example:

pt comes in for a high risk screening might look like this: CPT G0105
DX V12.72

pt comes in for a high risk screening but there are findings: CPT 45380
DX1 V76.51
DX2 211.3

of course I just put in generic numbers, but thats the gist of it.

This is true, but make sure on the line item to only link dx 2. Medicare only wants the screening dx on the claim in the 1st dx position to show it started as screening.

 

[coachlang3]

Thanks Lisa, I always forget to make that point.