Gastroenterology Coding Alert

Do you think you've got the correct codes on hand when an average risk Medicare patient comes in for a screening colonoscopy? Low- and high risk factors can change not only your codes, but frequency guidelines allowing the screening.

Five questions will detect problem areas and have you submitting clean claims in no time. For answers to these questions, turn to page 77.

Question 1: A 65-year-old average risk Medicare patient reports for a colonoscopy screening to check for colorectal cancer on March 2, 2008. The gastro-enterologist provides a normal screening and sends the patient home. How should you report this, and when can the patient have his next screening?

Question 2: A 64-year-old average risk patient has had a Medicare-covered cancer screening via flexible sigmoidoscopy two years ago. Is he eligible for a colonoscopy screening?

Question 3: Is a 48-year-old patient identified as high risk for colorectal cancer entitled to a screening colonoscopy? Why or why not?

Question 4: A 63-year-old Medicare patient reports for a colorectal cancer screening. The patient has a family history of colon cancer in a close relative. You want to submit a successful G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) claim. What is the best way to do that?

Bonus Question 5: A 62-year-old average risk patient presents for a screening colonoscopy, but the gastroenterologist finds a polyp during the screening. How should you report this, and what does this mean for frequency guidelines?