Screening colonoscopy

Is diagnosis code V18.51, family hx colon polpys included in high risk diagnosis. Also can you do a diagnostic colon using this diagnosis.

colonoscopy

Medicare will cover a screening colonoscopy for High risk and family hx of polyps is on the list for meeting high risk criteria. This would be for screening only as the patient themselves is not presenting with any signs or symptoms.

Screening colonoscopy

But do they have to be adenomatous polyps. Are you saying V18.51 is ok or does it have to be V16.0.

colonoscopy

V18.51 would be the correct dx because V16.0 is family history of Malig neo and a adenomatous polyp is usually benign.

Screening Colonoscopy

For a screening colonoscopy, if no procedure beyond the diagnostic endoscopy is performed, CPT/HCPCS code assignment depends upon whether or not the patient is a Medicare beneficiary. If the payer is Medicare, one of two HCPCS codes is required:

• G0105: Colorectal cancer screening; colonoscopy on individual at high risk

• G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

High risk implies one of the following conditions:

• A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyposis;

• A family history of hereditary nonpolyposis colorectal cancer;

• A personal history of adenomatous polyps;

• A personal history of colorectal cancer; or

• A personal history of inflammatory bowel disease, including Crohn's disease and ulcerative colitis.