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High Risk Colon Screening Colonoscopy

Camille Posted Sat 26th of October, 2019 21:51:01 PM
For this Medicare patient, a high risk screening colonoscopy exam (HCPCS G0105) the indications for colonoscopy exam are: Hx of Colonic Polyps and Family Hx of Colon Cancer. No therapeutic procedure was done during the colonoscopy. However, there was a diagnostic finding of Diverticulosis with a recommendation of high fiber diet. Since there was no therapeutic procedure performed is it appropriate to code G0105/Z12.11, Z86.010, Z80.0, K57.30? Or because there was a finding/diagnosis of diverticulitis, should I code 45378-PT/Z12.11, K57.30, Z86.010, Z80.0? Thank you very much!
SuperCoder Answered Tue 29th of October, 2019 06:06:50 AM

Hi Camille,

 

You should code G0105 -PT/Z12.11, K57.30, Z86.010, Z80.0

 

Screening colonoscopy procedures cannot turn into “diagnostic” procedures, but they can become therapeutic procedures depending on the findings

 

Example: Suppose a patient underwent his first screening colonoscopy. The provider finds polyps and removes them during the same encounter. This service would be considered as screening colonoscopy even though therapeutic services were also performed; because the initial intent of the procedure was screening. To report this kind of a scenario, you need to use the appropriate therapeutic colonoscopy procedure CPT® code.

 

For commercial and Medicaid patients, you may use CPT® code 45378 (Colonoscopy, flexible; diagnostic, including collection of specimens[s] by brushing or washing, when performed [separate procedure]), according to AGA.

 

For Medicare beneficiaries, you may use Healthcare Common Procedural Coding System (HCPCS) codes:

  • G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) or 
  • G0121 (Colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk) as appropriate.

 

Please find below SuperCoder news link for more understanding:

 

https://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/colonoscopy-master-your-screening-colonoscopy-coding-in-a-jiffy-153439-article

 

Thanks!

 

Camille Posted Sat 02nd of November, 2019 13:49:14 PM
Will you please clarify or verify? The Supercoder Modifier Details for "33" are similar to "PT." For a commercial payer, would I append modifier -33 to a Screening colonoscopy (45378-33) if there was a diagnostic finding of polyp or diverticulosis, even if it did not turn into a therapeutic service? For example: because polyp was noted but not removed or a discovery of diverticulosis. 45378-33 / Z12.11,K63.5, k57.30, Z86.010. Thank you very much.
SuperCoder Answered Mon 04th of November, 2019 03:00:34 AM

Hi Camille,

 

Modifier 33 is appropriate with a CPT or HCPCS code that is a diagnostic/therapeutic service that is being performed as a preventive service. In this case, it would be appropriate to use 33 modifier even though the service did not convert into therapeutic service.

 

Thanks!

Camille Posted Mon 11th of November, 2019 12:22:33 PM
This advice was revised in Ask an Expert subsequent question titled: "Colonoscopy Screening and when to us ICD-10 Z12.11." The above coding advice is correct except Modifier -PT is not to be used with the G codes.
SuperCoder Answered Tue 12th of November, 2019 03:15:30 AM

Hi Camille,

 

Thanks for the feedback.

 

I discuss this particular scenario with the coding expert who replied to the other query and posted the answer. Thank you once again for the feedback.

 

We appreciate it.

 

Camille Posted Tue 12th of November, 2019 11:59:56 AM
Thanks very much. I appreciate your advice and quick responses, always. I wanted to add the correction to this thread as well, for future reference. Thanks again!
SuperCoder Answered Wed 13th of November, 2019 00:29:19 AM

Thank you, happy to help.

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