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G0105

SuperCoder Posted Thu 11th of July, 2013 19:03:57 PM

I know that this question has been asked a hundred times. I billing Medicare 'G0105' using the DX 'V16.0'. They have denied stating that DX is not covered. I would like in writting from them that this code is not covered as in a LCD. I have only been able to get LCD L30059 and the HCPCS codes are not on this LCD. A retired LCD that was used when we had another payor has the 'G' codes (L6116). I have spend hours searching CMS website and can find nothing. Can you help? Thanks

SuperCoder Answered Fri 12th of July, 2013 11:27:29 AM

Colonoscopy for high risk screening doesn’t allow using V16.0 as the primary diagnosis code. You’ll have to use V76.41 or V76.51 depending on where the gastroenterologist performed the screening. V16.0 should be used as a secondary code to support the purpose of conducting the high risk screening in the patient.

An LCD that I was able to find in the CMS site was L27566. You can find it at the below mentioned link:

http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=27566&ContrId=171&ver=39&ContrVer=1&Date=07%2f01%2f2013&DocID=L27566&bc=iAAAAAgAAAAAAA%3d%3d&

Hope this helps.

SuperCoder Posted Mon 22nd of July, 2013 16:01:14 PM

Thank you for you response. Can you explain to me why they no longer consider this a valid code for high risk screening when the other carrier for this area did? Thanks

SuperCoder Answered Tue 23rd of July, 2013 23:20:30 PM

This been always a debatable topic and I cannot see a sure cut answer to this.

AAPC has also covered this topic. Please check with this links:

http://news.aapc.com/index.php/2013/03/colonoscopy-screening-or-surveillance/

I would come with more if I found something consulting with my editors.

Thanks

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