# Screening Colonoscopy high risk



## sherryo35 (Jul 28, 2014)

Please help. Is anyone else seeing denials for medical neccesity from Medicare when billing G0105 with dx V12.72? this just started for us in July and am getting no good direction with Medicare.


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## cynthiabrown (Jul 28, 2014)

Are you listing v76.51 as first dx??


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## lalit.pant (Jul 29, 2014)

sherryo35 said:


> Please help. Is anyone else seeing denials for medical neccesity from Medicare when billing G0105 with dx V12.72? this just started for us in July and am getting no good direction with Medicare.



G0105 is used when we code for high risk screening colonscopy and in such case V76.51 should be primary code.


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## sherryo35 (Jul 29, 2014)

We only use V76.51 when billing 45378 or G0121? we have never billed V76.51 with v12.72 for G0105


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## sherryo35 (Aug 13, 2014)

Update from Palmetto GBA  

Colorectal Cancer Screening 
Palmetto GBA is aware that providers are receiving denials on HCPCS codes G0105 and G0120 when billed with previously covered ICD-9 codes. Palmetto GBA is researching the issue with CMS.

Applies to:
Jurisdiction 11 Part B//General
Jurisdiction 11 Part B//Physician
Jurisdiction 11 Part B//Primary Care
Jurisdiction 11 Part B//Surgery
Railroad Medicare (RRB)//General - Railroad Medicare
Railroad Medicare (RRB)//Physician
Railroad Medicare (RRB)//Primary Care
Railroad Medicare (RRB)//Surgery


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## sherryo35 (Oct 2, 2014)

UPDATE FROM PALMETTO GBA
Status: 
Update 9/30/2014 - The processing system will be updated for HCPCS codes G0105 and G0120 to be allowed when ICD-9 codes V12.72, V160 & V18.51 are billed. This update will be retroactive to dates of service July 1, 2014. 

Once the system has been updated a mass adjustment will be completed. There is currently no estimated date when this update will be completed


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