Wiki Screening colonoscopies

[Colliemom]

When billing a screening colonoscopy for a patient with a personal hx of colon polyps, which G-code would you choose? Moderate or high risk? (G0121 or G0105)

 

[BABS37]

I would code it as high risk.

Beneficiaries are considered high risk if they have any of the following:
-a close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp
-a family history or adenomatous polyposisa family history of hereditary nonpolyposis colorectal cancer
-a personal history of adenomatous polyps
-a personal history of colorectal cancer
-a personal history of inflammatory bowel disease, including Crohn's and ulcerative colitis

There are some guidelines in the back of the ingenix version CPT book also.

Hope this helps!

 

[BABS37]

Oh, G0105- is screening for high risk patient and G0121 is screening on patient not meeting those above criteria on high risk. Medicare website also has coding guidelines to view as well.

 

[Mklaubauf]

You have to know what type of polyp they had. For Medicare to be considered high risk screening it must be a personal history of adenomatous polyps.

Hope that helps,
M. Klaubauf, CPC