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Screening colonoscopies

  1. #1
    Default Screening colonoscopies
    Medical Coding Books
    When billing a screening colonoscopy for a patient with a personal hx of colon polyps, which G-code would you choose? Moderate or high risk? (G0121 or G0105)

  2. #2
    I would code it as high risk.

    Beneficiaries are considered high risk if they have any of the following:
    -a close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp
    -a family history or adenomatous polyposisa family history of hereditary nonpolyposis colorectal cancer
    -a personal history of adenomatous polyps
    -a personal history of colorectal cancer
    -a personal history of inflammatory bowel disease, including Crohn's and ulcerative colitis

    There are some guidelines in the back of the ingenix version CPT book also.

    Hope this helps!

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  3. #3
    Oh, G0105- is screening for high risk patient and G0121 is screening on patient not meeting those above criteria on high risk. Medicare website also has coding guidelines to view as well.

    Brooke Bierman, CPC, CPB
    Coding & Billing Manager
    2014 President AAPC Des Moines Chapter

  4. Default
    You have to know what type of polyp they had. For Medicare to be considered high risk screening it must be a personal history of adenomatous polyps.

    Hope that helps,
    M. Klaubauf, CPC

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