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colonoscopy G codes

Jenny Posted Wed 07th of January, 2015 16:49:39 PM

Can you please explain the use of the colon screening procedures? Is the correct coding to use the G0105 or G0121 rather than 45378 or is it in addition? Also, the modifiers for 2015? We have heard mixed answers and not sure if its ok to continue to use 45378 along with a mod or need to use the G code. Thanks so much.

SuperCoder Answered Wed 07th of January, 2015 22:51:15 PM

Thanks for your question. When billing Medicare patients, you should use G0121; Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk and no other gastro-related symptoms. G0121 is billed once every 10 years. G0105; Colorectal cancer screening; colonoscopy on individual at high risk should be used when a patient is being seen for a screening colonoscopy but is at a high risk for developing colon cancer. G0105 can be billed once every two years.

45378; Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) would be used for a patient that:
-has a Non-Medicare insurance policy
-has current gastro-related symptoms or
-if the patient is seen for a screening colonoscopy that has turned diagnostic. This would apply when the indication for the procedure was for screening purposes but a problem has been identified. You would need to append a modifier PT; CRC screening test converted to diagnostic test or other procedure to 45378 for Medicare patients. Modifier 33 (preventative service) is used for Non-Medicare patients. You would not bill the G-code in addition to 45378.

Please see link for additional information.

https://www.supercoder.com/coding-newsletters/my-part-b-coding-alert/medicare-modifiers-modifier-pt-use-this-when-colorectal-screening-becomes-diagnostic-article

https://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/colonoscopy-screening-g0105-45378-apply-this-coding-combo-for-your-high-risk-patients-109407-article

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE0613.pdf

Jenny Posted Fri 09th of January, 2015 10:11:16 AM

Thank you so much for the clarification, that helped a lot!

SuperCoder Answered Fri 09th of January, 2015 10:14:34 AM

You are welcome.

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