Gastroenterology Coding Alert

A screening is just a screening, until the gastroen-terologist finds something and removes it.

"As soon as the gastroenterologist finds, say, a polyp, you can no longer report a screening G code for Medicare," says Beth Rudd, CPC, coding specialist with Tri-State Gastroenterology in Edgewood, Ky.

For example, if a polyp or lesion is removed during a screening exam, the screening procedure codes are no longer valid and the codes reported then become the appropriate "removal of" codes, says DeAnne T. Owens, CPC, coding specialist with Waccamaw Gastroenterology in Georgetown, S.C.

Three of Medicare's colorectal cancer screening codes, G0104 (Colorectal cancer screening; flexible sigmoidoscopy), G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) and G0121(Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk), have the stipulation that if a biopsy is performed or a growth is removed during the screening procedure, Medicare's screening G code(s) can no longer be reported. Instead, you need to report the service using the procedure's family of CPT Codes, i.e., the flexible sigmoidoscopy family of codes, 45330-45345.

Having to report CPT codes for screenings during which a biopsy is performed or a growth is removed mirrors CPT Codes Guidelines that say you only report a surgical endoscopy code when the gastroenterologist performs something during a diagnostic endoscopy.

For example, let's say a gastroenterologist performs a diagnostic flexible sigmoidoscopy, 45330 (Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). During the procedure, the gastroenterologist finds a lesion that he removes using a snare technique. The service should be coded 45338 ( with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) based on the CPT guideline that states "surgical endoscopy always includes diagnostic endoscopy."

Medicare's screening-turned-surgical services guideline follows suit: If during the course of a flexible sigmoidoscopy, a lesion or growth is detected that results in a biopsy or removal of the growth, the appropriate diagnostic procedure classified as a flexible sigmoi-doscopy with biopsy or removal should be billed and paid rather than code G0104.

So if a gastroenterologist discovers a polyp in the course of performing G0104 and removes it using hot forceps, you would report code 45333 ( with removal of tumor[s], polyps[s], or other lesion[s] by hot biopsy forceps or bipolar cautery).

Rely on Family

Once a gastroenterologist performs more than the screening, you have to choose the appropriate code from the endoscopic family of CPT codes, Rudd says. So if a screening flexible sigmoidoscopy turns into a surgical procedure, you need to report one or more of the following codes depending on what the gastroenterologist finds and reports performing: