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G0105, G0121 and 45378

Linda Posted Fri 11th of November, 2011 14:31:35 PM

I am in desperate need of help. We are also in the process of learning the many, many guidelines to colonoscopies. To use the G0105 or G0121? or when to use 45378? We started off just using 45378 on everything until we found out we are suppose to be using colonoscopy screening codes especially for patients 50 + with history of polyps or family history of cancer. So now I have been coding anyone over 50 and under 75 with either a high risk G0105 or a low risk G0121. With mostly V code diagnosis. Someone just told me that unless it states screening colonoscopy of the report we should not code it with a G code even if the patient is Medicare and over 50. EX.#1 56 year old Patient comes in with stomach pain and change in bowel habits and turns out to have nothing wrong. I have been coding this as a G0121 with dx 789.00. or EX.#2 Report states, Patient is a 60 year old with history of colon polyps ( they rarely tell us what there last colonoscopy was) next to the history of colon polyps, they say screening being done to evaluate. I would use G0105 with V12.72. Please help. I recently sent out hundreds of G0105's and G0121's codes for 50 and older patients assuming anything is considered a screening and what about the G0121? No LCD for this.They are getting paid but is this correct? Like the woman above with get both signs and symptoms and screening colonoscopy indications, and 80% of these mention diverticulosis found, but I still use screening codes. We are an Ambulatory Coding and Billing Company. I pray I don't have to resubmit all these claims, this is all a learning experience.

SuperCoder Answered Fri 11th of November, 2011 20:40:36 PM

Guidelines in Simple:
When the patient comes with signs and symptoms,or any other complaints for which Colonoscopy is ordered, then you can code for diagnostic colonoscopy code: 45378, also for Medicare.
All screening colonoscopy CPT code for Medicare involves a G code, be it high-risk or low-risk as stated by G codes in your question, supported by Primary Dx with a V code.
If a patient comes for a screening colonoscopy and in case if any abnormality say diverticulosis or polyp is found, then you should code appropriate diagnostic CPT code (not a G code) and the abonromality as Primary Dx(not V76.51).

Linda Posted Mon 14th of November, 2011 16:50:47 PM

thank you so much, It has been a little tough, since we are an ASC coding and billing company and several states away from the Centers. We have no way of knowing also when the last screening or diagnostic colonoscopy was done. I am getting ready to ask the admin to some of these centers to please indicate if they are screening or diagnostic onto the operative report since we are a high volume coding company it would help us just in case.

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