Steer clear of G0121 denials by observing 10-year rule. This colorectal cancer screening FAQ will provide you the coding ropes to start soaring through your coding duties with the greatest of ease. Q: Who's Eligible for Average-Risk Test? Any Medicare patient 50 years or older is eligible for a covered Medicare screening, confirms Dena Rumisek, CPC, biller at Michigan's Grand River Gastroenterology PC. Catch: Example: One bit of simplicity: V76.51 (Special screening for malignant neoplasms; colon). You might list other identified conditions secondarily, including diverticulosis (562.10) or hemorrhoids (455.0). Always list the V code first, however. Q: What If the Patient Had a Recent Sigmoidoscopy? The frequency rules differ depending on whether other related colorectal cancer tests were performed previously; if a patient has had a routine flexible sigmoidoscopy screening (G0104, Colorectal cancer screening; flexible sigmoidoscopy), he is not entitled to a screening colonoscopy for at least 48 months, advises Cynthia Swanson RN, CPC, senior managing consultant for Seim, Johnson, Sestak & Quist LLP in Omaha, Neb. Example: This patient is not now eligible under Medicare guidelines for a screening colonoscopy because it has been only three years since his sigmoidoscopy. Q: What Are the Rules for High-Risk Patients? A patient who is considered at high risk for colorectal cancer is entitled to a screening colonoscopy once every 24 months, Ray says. You'll list a V code (such as V10.05, Personal history of malignant neoplasm; large intestine; or V12.72, Personal history of certain other diseases; diseases of digestive system; colonic polyps) as the primary diagnosis for these tests -- most of the time. Exception: Example: Q: Can I Bill Private Payers for Screenings? It depends. Some private payers will reimburse for colonoscopy screenings -- their coding practices for these services, however, can differ from Medicare. Many U.S. states have passed legislation similar to the Medicare regulations requiring all health insurance carriers to cover routine colorectal cancer screening starting at age 50. Most non-Medicare payers accept 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing; with or without colon decompression [separate procedure]) for a screening colonoscopy, Ray relays. Before coding these services, check the payer's frequency and diagnosis guidelines. "Each carrier pays [for screenings] according to the patient's policy," she says. G codes possible: Best bet: