Gastroenterology Coding Alert

Question: What all comes under preventive colorectal cancer (CRC) screening services?

Mississippi Subscriber

Answer: The preventive colorectal screening services include tests such as:

• Fecal Occult Blood Test (FOBT): ( HCPCS code G0328 (Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous)
• Flexible sigmoidoscopy ( HCPCS code G0104 (Colorectal cancer screening; flexible sigmoidoscopy))
• CT colonography (CPT^® code 74263 (Computed tomographic (CT) colonography, screening, including image postprocessing)
• Colonoscopy ( HCPCS code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk)
• Cologuard^TM

Remember: A colonoscopy following a positive result from any of the above tests may not count as preventive screening, instead it may be deemed as diagnostic procedure.

Plus: Medicare covers Cologuard^TM services, but does not cover CT colonography.

As for other commercial payors, you may want to check up on the above points with them so as to be clear on the payor guidelines for these services.