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Gastroenterology Coding Alert

Reader Questions:

G0105 Screens Your Colorectal Cancer Coding Options

Question: The surgeon prepares a Medicare patient meeting high-risk criteria for a screening colonoscopy and inserts the scope. Due to extreme patient discomfort and inability to negotiate further, the surgeon decides that he must discontinue the procedure prior to completion. What should I report on the claim?Washington SubscriberAnswer: You would bill G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) and append modifier 53 (Discontinued procedure).Why: When your surgeon begins a screening exam for a Medicare patient but cannot advance the scope past the plenic flexure due to obstruction, patient discomfort or other complications, you should append modifier 53 to the appropriate screening exam G code. "This situation parallels those of diagnostic colonoscopies in which the provider is unable to complete the colonoscopy because of extenuating circumstances and must attempt a complete colonoscopy at a later time," explains Medicare policy as outlined in CMS Program Memorandum Transmittal AB-03-114, Change Request [...]


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