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Gastroenterology Coding Alert

Reader Question:

Use V Code As Secondary Diagnosis

Published on Sat Feb 01, 2003

Question: Our gastroenterologist performed a colonoscopy for a rectal bleed. The patient also had a strong family history of colon cancer. Am I correct to code 45378 and then G0105? Our pricing is set so that both the colonoscopy and G codes are priced the same. Do I need to use a modifier, such as modifier -59 (Distinct procedural service)?

California Subscriber Answer: Codes 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]) and G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) are both colonoscopy codes, and you would not report them both at the same time. If the procedure was performed for a rectal bleed, then you would use colonoscopy code 45378. You should report the primary diagnosis as 578.1 (Blood in stool) with V16.0 (Family history of malignant neoplasm; gastrointestinal tract) as the secondary code.  
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