Gastroenterology Coding Alert

Question: A 73-year-old established Medicare patient with average risk for colorectal cancer presents for a screening colonoscopy on Feb. 11, 2010. The patient's records reveal his last covered screening to be on Jan. 31, 2000. How should I report this scenario?

Florida Subscriber

Answer: On the claim, you should report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk). But make sure there is no need  or any therapeutic intervention during the colonoscopy.

Heads up: Diagnosis coding for all G0121 claims require only one ICD-9: V76.51 (Special screening for malignant neoplasms; colon). If the chart indicates a diagnosis of colitis, for example, then you shouldn't be reporting a screening. If you don't want a word from OIG and RAC auditors, you should make the chart notes and the procedure consistent.

-- Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel.