AAPC - Back to school
Results 1 to 7 of 7

Thread: G0121 for Colonoscopy (Medicare)

  1. #1
    Join Date
    Apr 2007

    Default G0121 for Colonoscopy (Medicare)

    AAPC: Back to School
    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
    Join Date
    Apr 2007
    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. #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
    Join Date
    Apr 2007

    Smile G0121 for Colonoscopy

    Thank MSRD for helpful post and information.


  5. #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
    Join Date
    Apr 2007
    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. #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.

Similar Threads

  1. Medicare Colonoscopy
    By duane.reissig@cox.net in forum Gastroenterology
    Replies: 6
    Last Post: 06-14-2013, 01:36 PM
  2. Colonoscopy, Medicare, G0121 vs. 45378
    By fredcpc in forum Gastroenterology
    Replies: 11
    Last Post: 12-14-2010, 04:39 AM
  3. G0121 Non Medicare Screen
    By dimme85 in forum Gastroenterology
    Replies: 2
    Last Post: 06-10-2010, 05:48 AM
  4. Medicare Colonoscopy
    By rcclary in forum Gastroenterology
    Replies: 1
    Last Post: 01-14-2009, 01:22 PM
  5. Non medicare colonoscopy
    By carol ann in forum Gastroenterology
    Replies: 6
    Last Post: 12-18-2008, 10:00 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.