Screening Colonoscopy - Is everyone else using codes

mbarker

Contributor
Local Chapter Officer
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Is everyone else using codes G0105 and G0121 for screening colonoscopy's with both commercial and Medicare payors?
 

scorrado

Expert
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293
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Bridgewater, VA
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The G codes are to be used for Medicare patients only. I have never used them for commercial payors and have never had an issue. Hope this helps!
 

cconroycpch

Guest
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69
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Palm Beach
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I have used the G codes for Medicare and Commercial carriers and have not had any problems with using them. What code would you use for a screening colonoscopy if you weren't using the G codes?
 

scorrado

Expert
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293
Location
Bridgewater, VA
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For commercial payors you would use 45378 and V7651 as your diagnosis. Your diagnosis tells the payor that it was for screening purposes. I accidently sent one of G codes to Blue Cross one time and it got denied so I feel certain that in my area that those particular G codes are for Medicare only. The best answer would be to check with the individual payors and see how they want it coded.
 

cedwards

Guru
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153
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Hamden
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It is my understanding that the G codes are for Medicare only. We use the 45378 for screening colon with the V76.51 dx. We have reportedthe G code to some of our carriers to see how they would pay and some reject it, some pay it in full and some reduce the payment. I would suggest contacting your carriers to see. We made a decision in our office to only report the G code to Medicare.
 

sundaey

Networker
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68
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Las Vegas
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hello,
I have been using the G code for screening coloscopies for all carriers, and using the V76.51 code for the dx. I haven't had any problems yet.
 

milema2

Contributor
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I am in VA and I use the G codes for commerical carriers, we do not have any problems.
Margie Miles, RMA, CPC, PCA
 

codegirl0422

Expert
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I am in Northern Alabama and we use the G codes for Medicare only. The majority of our other carriers do not except them. Our other major carrier is BCBS and they don't recognize G codes.
 

cwharvey

Guest
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I work in Indiana and since the beginning of 2008 we have had many calls from patients whose claims were denied. They are requesting their colonoscopy be submitted as "preventive". After talking to payer reps, we are now using G codes for all screenings that there are no findings to require a therapeutic procedure code, not just Medicare.
 
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