Gastroenterology Coding Alert

Question: A patient comes in for a follow up colonoscopy. The indication is chronic colitis, and the last colonoscopy was completed in 2005. He currently doesn't have any symptoms and has never been on any medicines to control it. Should we bill this encounter as a screening or as a diagnostic procedure? What codes should we report?

Oregon Subscriber

Answer: There are several high risk indications for follow-up colonoscopy at intervals more frequent than the every ten year routine screening colonoscopy. Patients with forms of ulcerative colitis (556.0-556.9) and Crohn's Disease (555.0- 555.9) have an increased risk of developing colon cancer andmay need follow-up colonoscopy as often as every two years depending on prior findings and activity of the disease. This increased risk of cancer and polyps may be present even when the disease is inactive and does not require regular medication.

Commercial carriers general consider colonoscopies performed for these high risk indications to be diagnostic, so you should code them with the appropriate CPT® from the colonoscopy family of codes (45378-45386) and the diagnosis code for the specific type of colitis. You should ask your physician for more specific information if the report just says "chronic colitis." For Medicare patients the correct code would be G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) instead of 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]) if the physician used no biopsies or other therapeutic techniques, but that will be very unusual in patients with forms of chronic colitis.