# Colonoscopy, Medicare, G0121 vs. 45378



## fredcpc

I know this topic has been on the forum a lot, but I have to bring it up again. Here is my office scenario:

Our Medicare patient comes in for a screening colonoscopy. His H&P is GERD, COPD, hypertension, and family hx of colon cancer.  Patient has no GI signs or symptoms at this time.   Colonoscopy done with finding of diverticulosis and internal hemorrhoids, no bx done.

Here is my coding for this Medicare pt: 45378, dx: V76.51, 562.10, 455.0

Any feedback on this?


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## mitchellde

If no bx or other diagnostic procedure was performed then the procedure code remains the G0121.


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## fredcpc

*Colonoscopy, Medicare, G0121*

Ok, so my dx order is good, but the px is changed to G0121. Thank you.

But...what if the Medicare patient presents with abdominal pain and nausea? Then, do we code use the 45378 with the same dx order?

Thank you for your patience and help.


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## mitchellde

No if the patient is symptomatic and the provider orders a colonoscopy because of the presenting symptoms then this is not screening at all it is diagnostic, so you would not use a screening diagnosis code.  If there are findings that explain the presense of the symptoms then this is what was being looked for so you code only the definitive finding, if there is no finding then code the symptoms that prompted the test.  Then you would use the CPT code for the appropriate colonoscopy.


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## fredcpc

*Colonoscopy, Medicare, G0121*

I am learning a lot, but please bear with me so I can bring this all together. I have to ask you how you would code the following two cases:

1) Medicare patient presents with Ab pain and nausea; gets C-scopy screening; findings are diverticulosis and internal hemorroids, no bx. Cpt and dx codes??

2) Medicare patient presents with no symptoms; hx of GERD, family hx of colon CA; C-scopy screening; findings are diverticulosis. Cpt and dx codes??

Thanx again...


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## mitchellde

Ok so I do not have my books with me (sittin in airport).. but
#1.  It is not a screening it is diagnostic due to the fact that the patient present with symptomatic issues that needed investigation so the procedure is the CPT for a diagnostic colonoscopy and the dx codes would be the diverticulosis and internal hemorroids.  We would not code the symptoms unless documentation supports that the findings were incidental and we still do not know the cuse for the symptoms, in that case the abd pain and nausea are first then the diverticulosis and the internal hemerroids.
#2 code the G code for the screening colonoscopy, the dx is the screening V code first, the hx of colon ca , diverticulosis as secondary dx codes.


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## mitchellde

Ok so I do not have my books with me (sittin in airport).. but
#1.  It is not a screening it is diagnostic due to the fact that the patient present with symptomatic issues that needed investigation so the procedure is the CPT for a diagnostic colonoscopy and the dx codes would be the diverticulosis and internal hemorroids.  We would not code the symptoms unless documentation supports that the findings were incidental and we still do not know the cuse for the symptoms, in that case the abd pain and nausea are first then the diverticulosis and the internal hemerroids.
#2 code the G code for the screening colonoscopy, the dx is the screening V code first, the hx of colon ca , diverticulosis as secondary dx codes.


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## fredcpc

*Colonoscopy, Medicare, G0121*

Aloha Debra,

I appreciate you taking the time and patience to answer my questions. Have a safe flight. I writing from Hawaii.

Much mahalo,
Fred


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## fredcpc

*Colonoscopy Medicare*

One more quick question on #2: Since the patient had a fam hx of Colon CA, would the G0105 be appropriate?

thanx...


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## mitchellde

I so wish I was with you in Hawaii!  It is very cold here right now.  Yes if it is documented as family hx of colon ca the the use of high risk screening is appropriate.


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## fredcpc

*Colonoscopy, Medicare, G0121*

Debra -- Where are you right now? I've heard about the snow storms in the mid-to-eastwestern states. We've had some rain storms here. 

So once last look at #2: I am going to code, G0105 (high risk), Dx(s): V76.51, V16.0, 562.10, 455.2. I thought about putting the V16.0 as the primary dx.

I hope you find some warmth over there. Thanx again.
Fred


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## mitchellde

I live in Missouri but I am in DC today.  COLD COLD COLD!  
OK #2 yes that is how I would do it.  I would not use the V16.0 primary unles the patient sole reason for the screening was due to the family histroy.  For example
"I need a screening colonoscopy because my brother was just diagnosed with colon cancer and he said the doctor advised all of us to be checked"  this to me makes the V16.0 first as it is the reason for the exam.  vs
" Ok i agree given my age I should have a screening colonoscopy.  Yes I remember my grandfather had colon cancer."  This is not the motivation but can elevate the risk of the patient so screeniong first.
Take care!


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