Gastroenterology Coding Alert

Question: Our gastroenterologist performed a colonoscopy on a patient with a prior history of colon cancer (asymptomatic at present). There were no negative findings with the colonoscopy. A colonoscopy done four years prior to this also had no findings of significance. How should I code this?

New York Subscriber

Answer: Since the patient has a previous history of colon cancer, the diagnosis should be coded as V10.05 (Personal history of malignant neoplasm of large intestine). Since the colonoscopy procedure that your gastroenterologist has performed is a routine screening for high risk patients (due to the previous history) you should report code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) if the patient has Medicare coverage.

If the patient has coverage under some other commercial carrier, then you can code the diagnosis as V10.05. You can code the procedure under 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]) with the modifier 33 (Preventive services) appended to show that the procedure was conducted for screening purposes.

More about modifier 33: CPT® modifier 33 is a new modifier that the AMA developed to help providers convey to the insurance payers a preventive service was performed without involving any patient co-sharing of payments.

As per CMS transmittal 2172, this modifier went into effect retroactively from Jan.1, 2011 (http://www.cms.gov/transmittals/downloads/R2172CP.pdf). As indicated in the available guidelines, the modifier can be used with CPT®, as well as HCPCS Level II prevention codes. It also conveys that the modifier is not to be used along with inherent preventive services codes.