Gastroenterology Coding Alert

In the 2007, Vol. 10, No. 3 Gastroenterology Coding Alert, "Reader Question: Watch Out for Screening Versus Surveillance" describes the two-year limitation for screening colonoscopies.

When your gastroenterologist performs a surveillance colonoscopy on a Medicare patient because of a personal history of polyps, you should count this as a high-risk screening and report G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) assuming the physician didn't find anything during the procedure, says Cecile M. Katzoff, MGA, CGCS, vice president for consulting services at the American Gastroenterological Association in Bethesda, Md.

The two-year limitation is only between two high-risk screenings.

Example: If the gastroenterologist performed an initial screening colonoscopy but found a polyp that he removed by snare, the case is no longer a screening colonoscopy and you would report 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique).

If the gastroenterologist chose to perform a colonoscopy 13 months later that was negative, you can report G0105, and your two-year limitation begins.

For the follow-up procedure more than two years later, you would report G0105 again for a Medicare patient or 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 non-Medicare patient and attach V12.72 (Personal history of certain other diseases; diseases of digestive system; colonic polyps). In this second instance, you do not have the two- year limitation. The two-year limitation begins only after the first high-risk screening, Katzoff says.

Important: This issue is significant for Medicare patients, because when you report a G code, Medicare waives its deductible. In addition, when you report 45378 with the V code for the diagnosis, Medicare will deny payment for the service, Katzoff says.