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Colonoscopy on Medicare patient

  1. #1
    Northeast Kansas AAPC
    Default Colonoscopy on Medicare patient
    Medical Coding Books
    I have a Medicare patient that in November 2010 underwent sigmoidectomy, colorectal anastomosis, ileostomy. The patient had nothing but trouble with her ileostomy and in March of this year underwent a Barium Enema which read out as "possible anastomotic stricture near the rectosigmoid junction." Patient was wanting her ileostomy taken down and prior to that physician performed a colonoscopy. It reads: Colonoscope was inserted into the anus. This was advanced to about 15-20 cm. some fecal material was present. This was evacuated with the evacuator. After evacuating this, I could not find a lumen which can be cannulated or ballooned. Extensive attempts at cannulating the rectal stump or looking at this area did not reveal any openings. After about 15 minutes of trying this, the procedure was terminated. I believe the pateint has a significant stricture of the rectosigmoid junction which would make it unsafe to close her ileostomy at this time.

    Would I still use CPT G0121 with diagnosis of stricture and attention to ileostomy? I would also put a modifier 53 since it had to be discontinued. Any input is appreciated.


  2. #2
    Sounds like 45378 to me with a diagnosis of stricture. And v44.2 like you suggested. Could also add v67.09 as the primary code (follow up exam after surgery). This is not really a screening exam as it's done prior to ileostomy closure and not for screening purposes but to ensure that the colon is ok prior to closure.

  3. Default
    I agree with CRS- it does get confusing, if you want to decide whether or not you should be using the G codes, remember why Medicare has PT modifier.
    The PT modifier was created so when a screening colonoscopy (G code) turns into a medical procedure (removing polyps, biopsies, etc.), you have a way to communicate that to the payer.
    G code colonoscopies are for patients who have no existing medical reason for a colonoscopy.
    If they have an existing medical reason (one that meets medical necessity guidelines), then it is NOT a screening colonoscopy and it would not be coded with a G code in the first place.

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