Forum - Questions & Answers

May 31st, 2022 - Endocenter 3 

Medicare Colonoscopy

I have a patient with a history of colon cancer, and I am not sure how to bill this.  Would I bill the screening code and the history code, along with G code high risk or 45378?  Any help would be appreciated.  Thank you.

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Jun 6th, 2022 - ChrisW   247  1 

re: Medicare Colonoscopy

There are generally two options for Medicare, review the code section for the most appropriate CPT/HCPCS G-codes reported to Medicare.

G0104 flexible sigmoidoscopy 
G0105 colonoscopy on individual at high risk

In addition, there are other codes that may be considered, look under Cancer Screenings G0106-G0121.

For commercial or other payers consider 45378 there is generally other work being done during the flexible colonoscopy. View the section "Colonoscopy, flexible, proximal to splenic flexure" section to determine the correct code selection in your CPT book or Find-A-Code.

45378 diagnostic, with collection of specimen (s), this is a separate procedure.
45379 if there was a removal of foreign body(s)
45380 if a biopsy was done

(For the complete list see 45378-45393)  
 
Diagnosis Codes
Report the encounter first and any additional code to identify additional information, such as family history· 

Z12.11 - Encounter for screening for malignant neoplasm of colon
Z80.0  Family history of malignant
 
Modifiers
In addition to reporting the Procedure and diagnosis codes, the use of modifiers will indicate the type of service without changing the codes. For separately reported services specifically identified as preventive, the modifier 33 should not be used.

33 - Preventive Services
PT - Colorectal cancer screening test; converted to diagnostic test or other procedure
 

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