Diverticulosis = high risk colonoscopy?

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I cannot for the life of me find this in my documentation or on the web.

A patient had his first screening colonoscopy for Medicare, but he has a history of diverticulosis. Does this constitute G0121 or G0105?

Thank you!
 
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Thank you!

Do you have any web sites that say that? Not that I doubt you, but I'd like to print it to put in the coding notebook I keep with little tidbits like this.
 

Pam Brooks

True Blue
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Are they currently being treated for the diverticulosis, and is that the reason for the colonoscopy? A colonoscopy is also done for surveillance of diverticular disease; not always cancer screening. If so, it's not a screening, it's diagnostic.

At any rate, the criteria for high risk colonoscopies is 42 CFR 410.37.

Centers for Medicare & Medicaid Services, HHS ? 410.37
(3) An​
individual at high risk for
colorectal cancer
means an individual
with?
(i) A close relative (sibling, parent,
or child) who has had colorectal cancer
or an adenomatous polyp;
(ii) A family history of familial adenomatous
polyposis;
ate Mar<15>2010 11:34 Oct 28, 2011 Jkt 223182 PO 00000 Frm 00386 Fmt 8010 Sfmt 8010 Q:\42\42V2.TXT ofr150 PsN: PC150

(iii) A family history of hereditary
nonpolyposis colorectal cancer;
(iv) A personal history of adenomatous
polyps; or
(v) A personal history of colorectal
cancer; or
(vi) Inflammatory bowel disease, including
Crohn?s Disease, and ulcerative
colitis.​
 
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