I will code G0105....
Beneficiaries at high risk for developing colorectal cancer are eligible once every 24 months. Medicare considers an individual who is at high risk for developing colorectal cancer as one who has one or more of the following:
Close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp.
Family history of familial adenomatous polyposis.
Family history of hereditary nonpolyposis colorectal cancer.
Personal history of adenomatous polyps.
Personal history of colorectal cancer.
IBD, including Crohn’s disease, and ulcerative colitis.
A surveillance colonoscopy can be performed at varying ages and intervals based on the patient’s personal history of colon cancer, polyps, and/or gastrointestinal disease. Patients with a history of colon polyp(s) are not recommended for a screening colonoscopy, but for a surveillance colonoscopy.
Medicare patients with a family history (first degree relative with colorectal and/or adenomatous cancer) may qualify as “high risk.” Colonoscopy for these patients would not be a “surveillance,” but a screening, reported with HCPCS Level II code G0105 Colorectal cancer screening; colonoscopy on individual at high risk.
Surveillance colonoscopy (CPT® 45378, G0105)
Patient does not have any gastrointestinal sign, symptom(s), and/or relevant diagnosis.
Patient has a personal history of colon cancer, polyps, and/or gastrointestinal disease.
Screening colonoscopies (code G0105) are covered at a frequency of once every 24 months for beneficiaries at high risk for colorectal cancer (i.e., at least 23 months have passed following the month in which the last covered screening colonoscopy was done). To determine the 23 month periods, start your count beginning with the month after the month in which a previous test/procedure was performed.
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 polyposis;
a family history of familial adenomatous polyposis;
a family history of hereditary nonpolyposis colorectal cancer;
a personal history of adenomatous polyps; or
a personal history of colorectal cancer; or
inflammatory bowel disease, including Crohn's Disease, and ulcerative colitis.
If during the course of the screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the growth, the appropriate diagnostic procedure classified as a colonoscopy with biopsy or removal should be billed and paid rather than code G0105.
This screening must be performed by a doctor of medicine or osteopathy.
Regards,
Chitrai Selvi B