Colorectal Cancer Screening: A Medicare Coding & Billing FAQ
Posted on 04. Sep, 2009 by in Hot Coding Topics
Steer clear of G0121 denials with these tips.
If you slip up on screening colonoscopy claims’ frequency guidelines and eligibility requirements, Medicare will pay you zilch. But our colorectal cancer screening FAQ provides you the coding the know-how you need to soar through your coding duties with the greatest of ease.
Q: Who’s Eligible for Average-Risk Test?
Any Medicare patient 50 years or older is eligible for a covered Medicare screening, confirms Dena Rumisek, CPC, biller at Michigan’s Grand River Gastroenterology PC.
Catch: These patients can have a colorectal cancer screening only once every 10 years, says Cheryl Ray, CCS, CPMA, of Atlantic Gastroenterology in Greenville, N.C. You’d be wise to pay attention to the frequency guidelines, as “Medicare is very stringent on the date … it has to be 10 years or longer — it can’t be 9 years and 360 days” between covered screening colonoscopies, assures Rumisek.
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Example: A 73-year-old established Medicare patient reports for a screening colonoscopy on Aug. 11, 2009. The patient’s records indicate that he last had a covered screening on July 31, 1995. On the claim, you should report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).
One bit of simplicity: Report G0121 if there is no need for any therapeutic intervention during the colonoscopy. All G0121 claims require only one diagnosis code: v76.51 (Special screening for malignant neoplasms; colon). You might list other identified conditions secondarily, including diverticulosis (562.10) or hemorrhoids (455.0).
Always list the V code first, however.
Q: What If the Patient Had a Recent Sigmoidoscopy?
The frequency rules differ depending on whether other related colorectal cancer tests were performed previously; if a patient has had a routine flexible sigmoidoscopy screening (G0104, Colorectal cancer screening; flexible sigmoidoscopy), he is not entitled to a screening colonoscopy for at...
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