tci Outpatient Facility Coding Alert - 2014 Issue 2

Reader Question: Start With G0105 for High Risk Medicare Screening Colonoscopies

Question: Should we use G0105 or 45380 when we bill a screening colonoscopy for a high risk Medicare patient? Florida Subscriber Answer: When reporting a screening colonoscopy for a high risk Medicare patient, you should submit the claim with the appropriate G code — namely, G0105 (Colorectal cancer screening; colonoscopy on individual at high risk). You should also report the appropriate diagnosis code to support your claim for G0105. For instance, if the patient previously had surgery for a colon cancer you would report the V code, V10.05 (Personal history of malignant neoplasm of large intestine) as the...

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