Gastroenterology Coding Alert

Question: We encountered a patient with a history of polyps. She is due for a surveillance screening and is now covered by Medicare. Since the patient has not had a screening with Medicare, could I use the V76.51 or just schedule her due to hx V12.72 with G0105?

Alabama Subscriber

Answer: You should use G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) and justify the procedure with V12.72 (Personal history of colonic polyps), so long as your physician’s documentation supports this. 

A patient who is considered at high risk for colorectal cancer is entitled to a screening colonoscopy as often as every 24 months depending on the nature of the risk. You’ll list a V code (such as V10.05, Personal history of malignant neoplasm; large intestine; or V12.72) as the primary diagnosis for these tests -- most of the time.

Exception: If a patient has a condition that automatically puts him at high risk for colorectal cancer, then you would list that condition as the primary diagnosis (for instance, Crohn’s disease, 555.9, Regional enteritis of unspecified site, or ulcerative colitis). Check your state local coverage determination (LCD) for your payer’s specific list.