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High Risk Colonoscopy

Randa Posted Wed 31st of August, 2011 13:32:33 PM

Patient had a hyperplastic polyp removed in 2006 and was told to schedule a follow up colonoscopy in five years. She has subsequently moved to our area and made an appointment with my GI. The patient has Medicare. My GI doesn't feel that a hyperplastic polyp is high risk and would have advised the patient to come back in 10 years for a "screening" colonoscopy. She doesn't want Medicare to deny the patients colonoscopy or put her in a high risk category that she doesn't belong in. I explained that we would code the case with G0105 and diagnosis V12.72 because of the hyperplastic polyps and that would be paid. Am I correct? There is no need for her to worry about this, right?

SuperCoder Answered Wed 31st of August, 2011 19:46:15 PM

As per Medicare guidelines, personal history of Colonic polyps can be considered high-risk, so can be billed with G0105 with Dx V12.72

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