• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
  • Important Note: We will be performing a scheduled maintenance on 1st November 2020. The site will be offline from 7:30PM (MT) till midnight. We apologize for any inconvenience this may cause.

Screening colonoscopies

Colliemom

Expert
Messages
400
Location
New Haven, CT
Best answers
0
When billing a screening colonoscopy for a patient with a personal hx of colon polyps, which G-code would you choose? Moderate or high risk? (G0121 or G0105)
 

BABS37

Expert
Messages
311
Location
Des Moines
Best answers
0
I would code it as high risk.

Beneficiaries are considered high risk if they have any of the following:
-a close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp
-a family history or adenomatous polyposisa 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 and ulcerative colitis

There are some guidelines in the back of the ingenix version CPT book also.

:) Hope this helps!
 

BABS37

Expert
Messages
311
Location
Des Moines
Best answers
0
Oh, G0105- is screening for high risk patient and G0121 is screening on patient not meeting those above criteria on high risk. Medicare website also has coding guidelines to view as well. :)
 

Mklaubauf

Guru
Messages
126
Best answers
0
You have to know what type of polyp they had. For Medicare to be considered high risk screening it must be a personal history of adenomatous polyps.

Hope that helps,
M. Klaubauf, CPC
 
Top