Medicare guidelines for high risk screening colons

ENDOCODER

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Sterling Heights, MI
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This has probably been discussed previously but I was at a Medicare Seminar yesterday and was told that when billing Medicare we should follow Medicare guidelines as opposed to AMA guidelines. Has anyone ever heard this before? So when a patient is coming for a colonoscopy due to history of polyps (no other signs or symptoms) we can bill the G0105 if doc doesn't find anything and history of polyps ICD10 code. Medicare allows a screening once every 24 months, high risk. We would not use 45378 since pt. had polyps previously?
Appreciate any help on this one.
 

cgaston

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Clarence, NY
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Medicare has been using their screening colonoscopy codes for years.

I don't know where I found it, but I have noted that CMS defines a high-risk patient as one who has one or more of the following factors:

- a close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp
- a family history of familial adenomatous polyposis
- a family history of hereditary nonpolyposis colorectal cancer
- a personal history of adenomatous polyps
- a personal history of colorectal cancer
- a personal history of inflammatory bowel disease, including Crohn's disease and ulcerative colitis

I use the G0105 for any Medicare patients noted to have any of the above.
 
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