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G0121 for Colonoscopy (Medicare)

  1. #1
    Default G0121 for Colonoscopy (Medicare)
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    My understanding of guidelines is that the only time you use the G0121 for medicare pt getting a Colonoscopy is when it is when it is an asymptomatic screening with no findings. Meaning the only dx code used is a V76.51. Any feedback on this?

  2. #2
    Columbia, MO
    I would agree that that is correct. Possible use a family hx dx and/or a personal hx dx if documented and appropriate, in addition tothe V76.51

    Debra A. Mitchell, MSPH, CPC-H

  3. Default RE:Medicare screening
    Medicare Screenings
    Please refer:

    If the patient is aymptomatic AND does not meet any of the high risk criteria mentioned below for colorectal cancer, you'd report PX code G0121 with a PDX of V76.51 (Special screening for malignant neoplasms;colon).

    G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk) with PDX as V76.51
    G0105 (Colorectal cancer screening;colonoscopy on individual at high risk) PDX reported with ANY listed HIGH risk icd mentioned

    Screening colonoscopies (G0105) are covered at a frequency of once every 24 months for beneficiaries at high risk for colorectal cancer (ie. at least 23 months have passed following the month in which the last covered screening colonoscopy was performed).

    Medicare will allow only select diagnoses to support a high risk classification. These may include:

    1. A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp (V16.0, V19.8);
    2. A family history of familial adenomatous polyposis (V19.8);
    a family history of hereditary nonpolyposis colorectal cancer (V16.0 & V19.8)
    3. A personal history of adenomatous polyps (V12.72); or
    a personal history of malignant neoplasm of the large intestine (V10.05)
    a personal history of colorectal cancer (V10.06); or
    a personal history of gastrointestinal cancer (V10.00, V10.03, V10.04, V10.07)
    Inflammatory bowel disease, including Crohn's Disease, and ulcerative colitis (555.0-555.2, 555.9-556.3, 556.8, 556.9, 558.2, 558.9).


  4. #4
    Smile G0121 for Colonoscopy
    Thank MSRD for helpful post and information.


  5. Default 75 year old with no disease problems
    Quote Originally Posted by fredcpc View Post
    My understanding of guidelines is that the only time you use the G0121 for medicare pt getting a Colonoscopy is when it is when it is an asymptomatic screening with no findings. Meaning the only dx code used is a V76.51. Any feedback on this?
    my instructor said that a 75 year old is a high risk, so therefore if the patient has no diseases the code would be g0102. i disagree

  6. #6
    Charlotte, NC
    Is the 75 y/o high risk because of age?

    High risk is for personal hx of adenomotous polyps or colorectal cancer or primary family hx of those same. Primary family is brother, sister, mother, father or children.

    I know Medicare just came out with guidelines for those over 75 though. Doesn't have anything to do with making them high risk if I remember. It had to do with coverage of a screening. Maybe they have to be high risk to have it covered after the age of 75?

  7. Default MCR Screenings
    These are seen regularly with things such as diverticulosis (562.10), and or with hemorrhoids, as they are considered ancillary findings. Just be careful of the 10 year rule. But then if there are any other findings or biopsies are taken those will turn the procedure.
    Generally over 70 it depends on the overall health of the patient, and if there has never been any polyps found the doctor may decide to discountinue regular screenings.

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