Internal Medicine Coding Alert

Published on Wed Jan 07, 2009 PDF

Avoid screening miscodes by sticking to your carrier's approved Dx list.

Your internist can recommend screening colonoscopies for Medicare patients more often than once a decade -- if the patient meets your Medicare carrier's high-risk guidelines.

Check out this primer on high-risk diagnosis patients, and ensure your G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) pay every time.

According to Medicare, a patient at high risk for colorectal cancer is eligible for a screening colonoscopy once every 24 months.

Note: Medicare eligibility for high risk screening colonoscopy does not equate to appropriate or necessary care. The American Cancer Society and the American College of Gastroenterology both have guidelines listing intervals for surveillance colonoscopy for specific conditions. Check these organizations'Web sites for more information.

An individual is at high risk for developing colorectal cancer has one or more of the following, confirms Cynthia Swanson, RN, CPC, senior managing consultant for Seim, Johnson, Sestak & Quist LLP in Omaha, Neb.:

• a first-degree relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp

• a family history of familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer

• a personal history of adenomatous polyps, malignant neoplasm of the large intestine, colorectal cancer, or gastrointestinal cancer

• inflammatory bowel disease, including Crohn's disease and ulcerative colitis.

Finding the exact ICD-9 codes your Medicare payer accepts for G0105 is a breeze; just go to its local coverage determination (LCD) and check out the list of acceptable diagnoses. Individual lists will vary, but the following ICD-9s will be on most Medicare payers' lists:

• V10.05 -- Personal history of malignant neoplasm; large intestine

• V10.06 -- ... rectum, rectosigmoid junction and anus

• V12.72 -- Personal history of certain other diseases; colonic polyps

• V16.0 -- Family history of malignant neoplasm; gastrointestinal tract

• 555.1 -- Regional enteritis; large intestine

• 555.2 -- ... small intestine with large intestine

• 555.9 -- ... unspecified site

• 558.2 -- Toxic gastroenteritis and colitis

• 558.9 -- Other and unspecified noninfectious gastroenteritis and colitis.