Gastroenterology Coding Alert

Question: Our gastroenterologist performed a colonoscopy for a rectal bleed on a Medicare patient. The patient also has a family history of colon cancer. Should I report both 45378 and G0105?


Tennessee Subscriber

Answer: No, you should not report both 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). Each of these codes describes colonoscopy, and reporting them both during the same session would be double-billing.

In this case, the colonoscopy is diagnostic rather than screening, with a primary diagnosis of 578.1 (Blood in stool). Therefore, you should report 45378 only. You may, however, cite V16.0 (Family history of malignant neoplasm; gastrointestinal tract) as a secondary diagnosis.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and a former member of the CPT advisory panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Lawrenceville, Ga.