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Screening High Risk Colonoscopy Medicare, Medicaid

Jackie Posted Fri 07th of December, 2012 22:22:07 PM

I have a question. When billing Medicare or Medicaid, you have a patient needing a Screening colonoscopy with High Risk, do you code V76.51, V12.72 with G0105?

SuperCoder Answered Fri 07th of December, 2012 23:05:30 PM

A patient who is considered at high risk for colorectal cancer is entitled to a screening colonoscopy once every 24 months, Ray says. "High risk" includes factors such a personal history of colon cancer, inflammatory bowel disease, or adenomatous polyps, or a family history of familial adenomatous polyposis or nonpolyposis colorectal cancer. You'll list a V code (such as V10.05 [History of colon cancer] or V12.72 [Diseases of digestive system; colonic polyps]) as the primary diagnosis for these tests.

If the patient already suffers from a condition that automatically put him at high risk for colorectal cancer, list that condition as the primary diagnosis.

Example: A 69-year-old established Medicare patient with a personal history of colonic polyps reports to the surgeon for a colonoscopy screening on Dec. 1, 2010. The patient record indicates that the patient's last colonoscopy screening was May 4, 2007. On the claim, report G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) with V12.72 appended.

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