Wiki G0105 Medicare NCD help needed

[cmhooten]

I have a claim denied by Medicare as DX in not covered under NCD. However when I tried to look up what DX are covered I can't seem to find one. The physician is billing out code G0105 with DX D50.0 and K64.1. I know this does seem correct.

 

[SharonCollachi]

Did you check online to see if the patient was able to have a screening colonoscopy for high risk patients? (every 24 months)

If you're billing with the dx codes you have listed, then it's not screening, it's diagnostic, with a different procedure code.

If it's truly screening, you would be looking at something like Z12.11, Z80.0, and/or Z86.010, for a regular screening colonoscopy, and you would add a dx that shows high risk, if that is the case, such as Crohn's disease (K50.80), for example.

You can go to CMS.gov and search on procedure code. Here is a link to an article on how to bill these. If that link doesn't work, search for Medical Policy Article A52378.

 

[cmhooten]

Thank you so much. I knew it did sound right but it has been awhile since I have done GI billing.

 

[cmhooten]

So I have another question. Different patient last colorectal cancer screening was done on 8/8/2018 however this patient then had a change in bowel habits so the physician did another colonectal screening (both were coded as G0105). I know that it has to be at least 24 months but I though that if the patient became systemic that we could bill a screening, am I incorrect?

 

[shlyalford]

No. It will no longer be a screening more so like a problem focus/ diagnostics to whatever the issue or disease may be for the change in bowel.

 

[cedwards]

So I have another question. Different patient last colorectal cancer screening was done on 8/8/2018 however this patient then had a change in bowel habits so the physician did another colonectal screening (both were coded as G0105). I know that it has to be at least 24 months but I though that if the patient became systemic that we could bill a screening, am I incorrect?

Shlyalford is correct, the second one would be diagnostic because the patient is having symptoms so you would use the CPT codes 453XX (last 2 digits depend on what was done, bx, snare, etc.) with the ICD-10 code for the change in bowel habits.