Preventive Medicine: Colorectal Cancer Screening

May 9th, 2018 - Find-A-Code™
Categories:   CPT® Coding   HCPCS Coding   Diagnosis Coding   Modifiers   Preventive Medicine Service   Oncology|Hematology  
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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: every 2 years (unless a screeningflexiblesigmoidoscopy has been performed and then Medicare may cover ascreeningcolonoscopy only after at least 47 months); and
  • 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.


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