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Gastroenterology Coding Alert

Reader Questions:

Reporting Both 45378 and G0105 Spells Trouble

Published on Tue Jun 17, 2008

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?Kentucky SubscriberAnswer: 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.
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