Preventive Medicine: Colorectal Cancer Screening

May 9th, 2018 - Find-A-Code™

Categories: CPT^® Coding HCPCS Coding Diagnosis Coding Modifiers Preventive Medicine Service Oncology|Hematology

Colorectal Cancer Screening

Procedure Codes
G0104: Colorectal cancer screening; flexible sigmoidoscopy
G0105: Colorectal cancer screening; colonoscopy on individual at high risk
G0106: Colorectal cancer screening; screening sigmoidoscopy, barium enema
G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
G0122: Colorectal cancer screening; barium enema
G0328: Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous
G0500: Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)
S0285: Colonoscopy consultation performed prior to a screening colonoscopy procedure
00811:Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified
00812:Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy
45346: Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)
45381: Colonoscopy, flexible; with directed submucosal injection(s), any substance
45300: Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
45305: Proctosigmoidoscopy, rigid; with biopsy, single or multiple
45308: Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery
45309: Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique
45315: Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique
45317: Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)
45330: Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
45331: Sigmoidoscopy, flexible; with biopsy, single or multiple
45333: Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps
45338: Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
45378: Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
45380: Colonoscopy, flexible; with biopsy, single or multiple
45384: Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps
45385: Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
45388: Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)
81528: Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result

82270: Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection)
82274: Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations
99152: Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older
99153: Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additional 15 minutes intraservice time (List separately in addition to code for primary service)
99241: Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99242: Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified healthcare professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99243: Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99244: Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99245: Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 80 minutes are spent face-to-face with the patient and/or family.

Frequency
G0104-G0106, G0121, G0328, 82270
Normal Risk:

Cologuard™ Multitarget Stool DNA (sDNA) Test: once every 3 years;
Screening FOBT: every year;
Screening flexible sigmoidoscopy: once every 4 years (unless a screening colonoscopy has been performed and then Medicare may cover a screening flexible sigmoidoscopy only after at least 119 months);
Screening colonoscopy: every 10 years (unless a screening flexible sigmoidoscopy has been performed and then Medicare may cover a screening colonoscopy only after 47 months); and
Screening barium enema (as an alternative to covered screening flexible sigmoidoscopy)

High Risk:

Screening FOBT: every year;
Screening flexible sigmoidoscopy: once every 4 years;

Screeningcolonoscopy

screeningflexiblesigmoidoscopy

ascreeningcolonoscopy

Screening barium enema (as an alternative to covered screening flexible sigmoidoscopy or colonoscopy)

All other codes in this section: Depends on the risk and other factors, consult your payer

ICD-10-CM
81528: Z00.00 Z00.01 Z01.411 Z01.419 Z12.10 Z12.11 Z12.12 Z12.13 R19.5
G0104-G0106, G0121-G0122, G0328, G0500, 82270, 82274, 45330-45333, 45338, 45346, 45378, 45380-45381, 45384-45385, 45388, 45300, 45305, 45308, 45309, 45315-45317, 99152-99153: Z83.71, Z83.79, Z12.12, Z12.10, Z12.11, R19.5
S0285, 99241-99245: Z12.11, Z83.81, Z83.79

Additional Information
G0104-G0106, G0121, G0328, 82270

These are the only codes for colorectal cancer screening covered as preventive with Medicare
For those aged 50 and older, or anyone at high risk

G0104-G0106

When these services are provided initially, all surgical procedures provided on the same date and in the same encounter do not require a deductible, this can be indicated on the other surgical procedure code with modifier PT

G0106

Copayment and/or deductible may still apply. Consult your payer

81528

For beneficiaries aged 50-75

G0121

No age limitation, for individuals not meeting criteria for high risk

S0285, 99241-99245

Must be billed with modifier 33 to be considered preventive

00811, 00812, Modifier PT

Effective for claims with dates of service on or after January 1, 2018, Medicare will pay claim lines with new CPT code 00812 and waive the deductible and coinsurance. When a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia services are reported with CPT code 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscopy introduced distal to duodenum; not otherwise specified) and with the PT modifier.

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

###

Questions, comments?

If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.

Latest articles: (any category)

What’s Going on with the COVID Vaccines Now?
May 4th, 2023 - Wyn Staheli

Keeping up with the changes to the COVID vaccines has certainly been a rollercoaster ride and we now have two new twists to this exciting ride. Buckle up and let’s look at how this changes things.

Reporting Modifiers 76 and 77 with Confidence
April 18th, 2023 - Aimee Wilcox

Modifiers are used to indicate that a procedure has been altered by a specific circumstance, so you can imagine how often modifiers are reported when billing medical services. There are modifiers that should only be applied to Evaluation and Management (E/M) service codes and modifiers used only with procedure codes. Modifiers 76 and 77 are used to identify times when either the same provider or a different provider repeated the same service on the same day and misapplication of these modifiers can result in claim denials.

Five Documentation Habits Providers Can Use Implement to Improve Evaluation & Management (E/M) Scoring
April 11th, 2023 - Aimee Wilcox

Provider education on E/M coding updates is vital to the success of any organization, but how do you whittle down the massive information into bite-sized pieces the providers can learn in just a few minutes? Check out the five steps we have identified to teach providers in just a few minutes that can significantly impact and improve coding outcomes.

Second Quarter 2023 Updates are Different This Year
April 6th, 2023 - Wyn Staheli

The second quarter of 2023 is NOT business as usual so it is important to pay attention to ensure that organizational processes and training take place to avoid mistakes. Not only have ICD-10-CM coding updates been added to the usual code set updates (e.g., CPT, HCPCS, ICD-10-PCS), but the end of the COVID-19 Public Health Emergency will bring about changes that will also take place during the quarter (but not on April 1, 2023.

7 Measures Developed by the HHS Office of Inspector General (OIG) to Identify Potential Telehealth Fraud
March 28th, 2023 - Aimee Wilcox

A recent review of telehealth services reported in Medicare claims data during the pandemic where these seven measures for identifying suspected fraud, waste, and abuse were applied, revealed more than a thousand Medicare providers potentially committed fraud during this period. What are the measures the OIG applied during their review, and how will that impact future telehealth guidelines moving forward?

MUEs and Bilateral Indicators
March 23rd, 2023 - Chris Woolstenhulme

MUEs are used by Medicare to help reduce improper payments for Part B claims. This article will address the use of the National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) and how they are used by CMS.

It is True the COVID-19 PHE is Expiring
March 16th, 2023 - Raquel Shumway

The COVID-19 PHE is Expiring, according to HHS. What is changing and what is staying the same? Make sure you understand how it will affect your practice and your patients.