Gastroenterology Coding Alert

Explore the new options for coding past history, pre-colonoscopy consultation, and more.

It’s all about quality in physician reporting these days, and having new HCPCs codes that provide additional information about why a patient needed a colonoscopy could benefit your practice.

Good indicators: “These new HCPCS codes are meant to relay information about the patient to help carriers understand the reasons for medical services and /or compare variations in medical care between providers,” says Michael Weinstein, MD, president & CEO of Capital Digestive Care, Silver Spring, Md. “Using these codes is not a means to generate any immediate additional revenue but may be decrease payer requests for records or identify your provider as providing quality service. More such codes are likely to be added in the future.”

Here’s the lowdown on the three codes you can use this year on your claims:

Past history of colon cancer: To report patients with a past history or diagnosis of total colectomy or colorectal carcinoma, you will have to choose G9711 (Patients with a diagnosis or past history of total colectomy or colorectal cancer) beginning with January 1, 2017.

Not having a 10-year follow-up: If your provider does not recommend a 10-year follow up period, then he will have to document the reason for a different interval and report G9862 (Documentation of medical reason[s] for not recommending at least a 10 year follow-up interval [e.g., inadequate prep, familial or personal history of colonic polyps, patient had no adenoma and age is = 66 years old, or life expectancy < 10 years old, other medical reasons])

Consult before the screening scope: For consul­tations before the patient has the screening, report S0285 (Colonoscopy consultation performed prior to a screening colonoscopy procedure).

In general, you may not bill pre-colonoscopy consul­tations separately as these are considered to be included in the colonoscopy code. However, some payers may now allow reporting of S0285 instead of an evaluation and management (E/M) code for non–Medicare patients. It is better to check with your payers to ensure their pre-colonoscopy consultation billing policy.

Resource: To read more about the list of new codes, go to https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3674CP.pdf.