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G codes for colonoscopy and sigmoidoscopy


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Kind of new at this. Do I use G0104 for a Medicare patient who had a sigmoidoscopy with a biopsy? It doesn't specify biopsy so not sure. What code would I use for a Medicare patient who had a colonoscopy through a stoma with biopsies? I know which CPT codes to use, but the G codes don't seem specific enough. Thanks for the help.
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Welcome Kathie,

You wouldn't use the G codes in that case. The G codes a specified for Medicare screenings. Some other carriers in different states use them too, but basically if a Medicare patient comes in for a screening colonoscopy and the procedure doesn't change to diagnostic (taking a biopsy, removing a polyp) you would use G0121. If a high risk Medicare patient comes in for a screening colonoscopy(a patient with history of colon cancer, first degree familly history of colon cancer, etc) and the procedure doesn't change to diagnostic you would use G0105. This same rule applies for the sigmoidoscopies, just different G codes. If a Medicare patient comes in for a screening sigmoidoscopy and the doc takes a biospy you would code it as 45331-PT. The PT modifier indicates that he came in for a screening. If the Medicare patient came in for other reasons like diarrhea your would just code the 45331.

Its a good idea to go back in these forums and read some of the discussions. That definitely helped me a lot. There are a few different interpretations of some rules, so make sure to use the http://www.cms.gov website and others for determination.

Sorry if that was a little confusing,



True Blue
Charlotte, NC
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No, the G codes are for screenings with no findings. Was it a flex sig w/biopsy? 45331
colon via stoma?44389

Oops Bob and I must've been typing at the same time. He however gave a much better explanation, lol.