Gastroenterology Coding Alert

For Medicare patients, personal and family history can determine how you code a screening colonoscopy and, depending on the patient's age, could determine eligibility. You should report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk) when your physician performs a screening on an average-risk patient, or G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) for a high-risk patient.

Medicare has no age requirement for G0105. "For beneficiaries considered to be at high risk for developing colorectal cancer, Medicare covers one screening colonoscopy every two years, regardless of age," according to MLN Matters article SE0613.

How you know: Cite V codes when reporting high-risk screening colonoscopies (G0105). Some diagnoses that justify Medicare screening colonoscopies include:

• Personal history of colorectal cancer --V10.05 (Personal history of malignant neoplasm; gastrointestinal tract; large intestine)

• Personal history of inflammatory bowel disease, including Crohn's disease and ulcerative colitis -- V12.72 (Personal history of certain other diseases; diseases of digestive system; colonic polyps)

• Personal history of adenomatous polyps V12.79 -- (Personal history of certain other diseases;diseases of digestive system; other)

• A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp (a type of polyp that could become cancerous) --V16.0 (Family history of malignant neoplasm; gastrointestinal tract)

• A family history of hereditary nonpolyposis colorectal cancer (a type of colorectal cancer that runs in families and tends to cause cancer at a relatively young age -- under 45 years) --V16.0 (Family history of malignant neoplasm; gastrointestinal tract)

• A family history of familial adenomatous polyposis (this involves multiple adenomatous polyps,often in the hundreds, and carries a very high risk of colon cancer) -- V18.5 (Family history of certain other specific conditions; digestive disorders).