General Surgery Coding Alert

Question: Can we use the prolonged service codes G0513 and G0514 for screening colonoscopies?

Oregon Subscriber

Answer: Yes, you can use the HCPCS prolonged service codes for preventative screening with the HCPCS screening colonoscopy codes under certain circumstances.

CMS introduced the prolonged service codes G0513 (Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)) and G0514 (… each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service)) with the 2018 Medicare Physician Fee Schedule (MPFS) final rule.

The final rule includes a list of preventive service codes and their “typical service time” that could be subject to adding G0513 and G0514. The list includes the following screening colonoscopy codes:

• G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) and
• G0121 (… colonoscopy on individual not meeting criteria for high risk).

CMS derived the time from the typical time assumed for MPFS rate-setting, and that was 30 minutes for both G0105 and G0121.

How to: If your surgeon performs a screening colonoscopy and documents complicating factors that make the procedure take longer than 30 minutes, you can code G0513 for the first additional 30 minutes of work and G0514 beyond that time in addition to the primary procedure code (G0105 or G0121). You must have documentation of patient conditions, such as tortuous colon or poor prep, that increases the endoscopy time, as well as documentation of the time.