Wiki Screening Colonoscopies , CPT and G code

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Coder_Rick

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Hello!

Quick question regarding Colonoscopies and Medicare.
If a patient has a screening performed in the hospital I know you use G0121 or G0105. But should I also code the 45378 and I saw reference to Modfier PT (33)? Also what if done in the office?
 
Hi. You would only code the G0121 or G0105 with the screening DX V76.51 for medicare patients.
 
OK for any screening procedure (as long as nothing is found during the procedure) you would use the following codes:

G0121 and V76.51 (if the patient has no primary family or personal history of cancer or polyps)

G0105 and V12.72,v10.xx, V16.0 or V18.51 (this if or a patient who is hig risk which is constituted by a personal history of polyps or colon cancer or a primary family history of colon cancer or polyps)

Some payors don't accept the G codes (not many but some) and according to your contract may want you to use the 45378 in place of the G code. Not sure why.

The 33 modifier is for non-Medicare payors. If the pt comes in for a screening procedure and something is found during the procedure you would append the 33 modifer. ie-a polyps is snared you would code 45385 (for the snare) with the following dx: V76.51, 211.3. There are debates about using the V code in the first slot. Take a look at previous posts about this.

The PT modifier is for Medicare use. For the same reasons as the 33 modifier.
If a pt with no history comes in for a screening procedure and nothing is found you would code: G0121 with V76.51. With a history: G0105 with V12.72 (or other history dx code). With Findings but no history: 45380 (or other CPT code) with a V76.51 and 211.3 along with the PT modifier. With finding and with history: 45380 with V12.72 and 211.3 adn the PT modifier attached.
 
G0121 and G0105 are strictly medicare hcpcs only.

Effective Jan. 1, 1998, Medicare created HCPCS Level ll codes G0105 and G0121. These codes are equivalent to and are used in place of CPT code 45378 when reporting outpatient colonoscopies for screening of colorectal cancer on Medicare patients. Code G0105 is used for reporting a screening colonoscopy for patients who are at high risk for colorectal cancer. High risk for colorectal cancer means an individual with one or more of the following:

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.

inflammatory bowel disease, including Crohn's Disease and ulcerative colitis.

HCPCS Level II code G0121 was created to report colonoscopies performed for colorectal screening on patients not meeting criteria for high risk. If an abnormality is found during a screening colonoscopy that results in a therapeutic procedure (e.g., biopsy, polypectomy, excision of lesion), then the appropriate CPT code is used instead of HCPCS Level II codes G0105 or G0121.
 
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