G0105 vs G0121
From Medicare LCD L27566 for Southern California:
"G0105 - Colorectal Cancer Screening; Colonoscopy on Individual at High Risk
Screening colonoscopies (code G0105) may be paid when performed by a doctor of medicine or osteopathy at a frequency of once every 24 months for beneficiaries at high risk for developing colorectal cancer (i.e., at least 23 months have passed following the month in which the last covered G0105 screening colonoscopy was performed).
Characteristics of the High Risk Individual:
An individual at high risk for developing colorectal cancer has one or more of the following:
A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp;
A family history of familial adenomatous polyposis;
A family history of hereditary nonpolyposis colorectal cancer;
A personal history of adenomatous polyps;
A personal history of colorectal cancer; or
Inflammatory bowel disease, including Crohn's Disease, and ulcerative colitis.
NOTE: If during the course of the screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the growth, the appropriate diagnostic procedure classified as a colonoscopy with biopsy or removal should be billed and paid rather than code G0105.
When a covered colonoscopy is attempted but cannot be completed because of extenuating circumstances, Medicare will pay for the interrupted colonoscopy as long as the coverage conditions are met for the incomplete procedure. "
AND
"Personal or family history of gastrointestinal neoplasia:
211.3 BENIGN NEOPLASM OF COLON
211.4 BENIGN NEOPLASM OF RECTUM AND ANAL CANAL
235.2 NEOPLASM OF UNCERTAIN BEHAVIOR OF STOMACH INTESTINES AND RECTUM
V10.00 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF UNSPECIFIED SITE IN GASTROINTESTINAL TRACT
V10.05* PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LARGE INTESTINE
V10.06* PERSONAL HISTORY OF MALIGNANT NEOPLASM OF RECTUM RECTOSIGMOID JUNCTION AND ANUS
V10.07 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LIVER
V12.72 PERSONAL HISTORY OF COLONIC POLYPS
V12.79 PERSONAL HISTORY OF OTHER SPECIFIED DIGESTIVE SYSTEM DISEASES
V16.0 FAMILY HISTORY OF MALIGNANT NEOPLASM OF GASTROINTESTINAL TRACT
V18.51 FAMILY HISTORY, COLONIC POLYPS
V76.41 SCREENING FOR MALIGNANT NEOPLASMS OF THE RECTUM
V76.51 SPECIAL SCREENING FOR MALIGNANT NEOPLASMS COLON
*
Diagnosis codes included on the “Partial List of ICD-9-CM Codes Indicating High Risk”
Chronic Digestive Disease Condition:
555.0* REGIONAL ENTERITIS OF SMALL INTESTINE
555.1* REGIONAL ENTERITIS OF LARGE INTESTINE
555.2* REGIONAL ENTERITIS OF SMALL INTESTINE WITH LARGE INTESTINE
555.9* REGIONAL ENTERITIS OF UNSPECIFIED SITE
556.0* ULCERATIVE (CHRONIC) ENTEROCOLITIS
556.1* ULCERATIVE (CHRONIC) ILEOCOLITIS
556.2* ULCERATIVE (CHRONIC) PROCTITIS
556.3* ULCERATIVE (CHRONIC) PROCTOSIGMOIDITIS
556.4 PSEUDOPOLYPOSIS OF COLON
556.5 LEFT-SIDED ULCERATIVE (CHRONIC) COLITIS
556.6 UNIVERSAL ULCERATIVE (CHRONIC) COLITIS
556.8* OTHER ULCERATIVE COLITIS
556.9* ULCERATIVE COLITIS UNSPECIFIED
*
Diagnosis codes included on the “Partial List of ICD-9-CM Codes Indicating High Risk”
Inflammatory Bowel:
558.1 GASTROENTERITIS AND COLITIS DUE TO RADIATION
558.2* TOXIC GASTROENTERITIS AND COLITIS
558.3 ALLERGIC GASTROENTERITIS AND COLITIS
558.41 EOSINOPHILIC GASTROENTERITIS
558.42 EOSINOPHILIC COLITIS
558.9* OTHER AND UNSPECIFIED NONINFECTIOUS GASTROENTERITIS AND COLITIS
*
Diagnosis codes included on the “Partial List of ICD-9-CM Codes Indicating High Risk” "
Where ever you are from or who your MAC is you should be able to look up the LCD and NDC to help with situations like this. Hope this helps!