Hope this helps
I found this information with regard to your question--I hope this helps. You may want to research a bit further as well to insure you are coding correctly.
Consider patient history and reason for the visit for accurate diagnosis coding.
The advent of the Affordable Care Act (ACA) has increased patient access to a greater number of preventative services. Physicians and patients have both benefited from this new law. Patient disease processes are being diagnosed at an earlier stage, ensuring less invasive treatments and better outcomes, while physicians are seeing an increase in revenue for preventative services.
Practices performing colonoscopies for colon and rectal cancer screenings have seen a corresponding rise in requests for ?screening? colonoscopy. As a result, there is an increase in incorrectly coded colonoscopies. Practices may not understand that a majority of patients are actually not screening colonoscopies, but are following surveillance regimens. There are several steps you must take to determine the difference and correctly code colonoscopy.
Step 1: Define Screening vs. Surveillance Colonoscopy, Determine Patient Need
Physicians and coders must be able to distinguish between a screening and surveillance colonoscopy. As defined by The U.S. Preventive Services Task Force (USPSTF):
A screening colonoscopy is performed once every 10 years for asymptomatic patients aged 50-75 with no history of colon cancer, polyps, and/or gastrointestinal disease.
A surveillance colonoscopy can be performed at varying ages and intervals based on the patient?s personal history of colon cancer, polyps, and/or gastrointestinal disease. Patients with a history of colon polyp(s) are not recommended for a screening colonoscopy, but for a surveillance colonoscopy. Per the USPSTF, ?When the screening test results in the diagnosis of clinically significant colorectal adenomas or cancer, the patient will be followed by a surveillance regimen and recommendations for screening are no longer applicable.?
The USPSTF does not recommend a particular surveillance regime for patients who have a personal history of polyps and/or cancer; however, surveillance colonoscopies generally are performed in shortened intervals of two to five years. Medical societies, such as the American Society of Colon and Rectal Surgeons and the American Society of Gastrointestinal Endoscopy, regularly publish recommendations for colonoscopy surveillance.
The type of colonoscopy will fall into one of three categories, depending on why the patient is undergoing the procedure.
Diagnostic/Therapeutic colonoscopy (CPT? 45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure))
Patient has a gastrointestinal sign, symptom(s), and/or diagnosis.
Preventive colonoscopy screening (CPT? 45378, G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk)
Patient is 50 years of age or older
Patient does not have any gastrointestinal sign, symptom(s), and/or relevant diagnosis
Patient does not have any personal history of colon cancer, polyps, and/or gastrointestinal disease
Patient may have a family history of gastrointestinal sign, symptom(s), and/or relevant diagnosis
Exception: Medicare patients with a family history (first degree relative with colorectal and/or adenomatous cancer) may qualify as ?high risk.? Colonoscopy for these patients would not be a ?surveillance,? but a screening, reported with HCPCS Level II code G0105 Colorectal cancer screening; colonoscopy on individual at high risk.
Surveillance colonoscopy (CPT? 45378, G0105)
Patient does not have any gastrointestinal sign, symptom(s), and/or relevant diagnosis.
Patient has a personal history of colon cancer, polyps, and/or gastrointestinal disease.