Gastroenterology Coding Alert

Question: If a Medicare patient is having a colonoscopy due to family history of colon cancer, what code should I use as the primary diagnosis, V16.0 or V76.51? The only reason he is having this is the family history.

Iowa Subscriber Answer: You should report V16.0 (Family history of malignant neoplasm; gastrointestinal tract) to represent the family history.

Keep in mind: You should consider this a high-risk screening. For these types of patients, Medicare processing may approve screenings every two years for Part B beneficiaries over age 50.

On the other hand, the current guidelines, espoused by the major GI societies and the U.S. Multi-Society Task Force on Colorectal Cancer, recommend an interval of five years for individuals with a family history of colon cancer or adenomatous colonic polyps in first-degree relatives. For these screenings, you should report G0105 (Colorectal cancer screening; colonoscopy on individual at high risk).

You shouldn't report V76.51 (Special screening for malignant neoplasms; colon) because most carriers accept this code for screening colonoscopies of average-risk patients. You would report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk) for this type of screening.