![]() inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis.a personal history of colorectal cancer.a personal history of adenomatous polyps.a family history of hereditary nonpolyposis colorectal cancer.a family history of familial adenomatous polyposis.a close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp.High risk for colorectal cancer means an individual with one or more of the following: Code G0105 is used for reporting a screening colonoscopy for patients who are at high risk for colorectal cancer. These codes are equivalent to and are used in place of CPT code 45378 when reporting outpatient colonoscopies for screening of colorectal cancer on Medicare patients. 1, 1998, Medicare created HCPCS Level ll codes G0105 and G0121. Therefore, if any other procedure but a brushing or a washing is performed during the diagnostic colonoscopy, code 45378 should not be reported in addition to surgical colonoscopy codes 45380-45385.Įffective Jan. All surgical colonoscopy codes include a diagnostic colonoscopy. Once the above factors are determined, use the following information as guidance to determine when each of the following codes is reported.Ĭode 45378, Colonoscopy, flexible, proximal to the splenic flexure diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression is used to report diagnostic colonoscopies. Was another procedure(s) performed during the diagnostic colonoscopy?.There are a number of factors that coders need to determine before assigning one of the above colonoscopy codes. G0121–Colorectal screening colonoscopy on individual not meeting criteria for high risk.G0105–Colorectal cancer screening colonoscopy on individual at high risk.45385–Colonoscopy, flexible, proximal to the splenic flexure with removal of tumor(s), polyp(s), or other lesion(s) by snare technique.45384–Colonoscopy, flexible, proximal to the splenic flexure with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery.45383–Colonoscopy, flexible, proximal to the splenic flexure with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.45381–Colonoscopy, flexible, proximal to the splenic flexure with directed submucosal injection(s), any substance.45380–Colonoscopy, flexible, proximal to the splenic flexure with biopsy, single or multiple.45378–Colonoscopy, flexible, proximal to the splenic flexure diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression.To determine correct code assignment, the code descriptions, their similarities and the intended use of the codes need to be evaluated and understood.Ĭolonoscopy procedures discussed in this article include CPT codes 45378 through 45385 and HCPCS Level II codes G0105 and G0121: The code assignment is determined by the physician’s documentation of the procedure performed or the method used to remove the tissue, lesion or polyp. A colonoscopy includes an examination of the entire colon, from the rectum to the cecum, and may also include examination of the terminal ileum. The colonoscope is inserted in the anus and the scope is advanced through the colon past the splenic flexure. Other instruments, such as biopsy forceps, can be passed through the colonoscope to perform procedures such as tissue biopsy and polypectomy. The instrument used in a colonoscopy is a flexible, thin tube with a video camera and light at the end called a colonoscope. Examples of therapeutic procedures include colonoscopies performed for polyp removal, biopsy, removal of a foreign body or tube, catheter placement or bleeding control.Īn endoscopy is a technique for examining the lumen (hollow part) of an organ. A personal or family history of colon cancer or polyps would also be an indication for a colonoscopy examination. Indications for a diagnostic procedure include abnormal rectal examinations, blood in stool, severe pain or discomfort, chronic diarrhea or change in bowel habits, weight loss or anemia. Coding colonoscopies has proved to be a challenge to coders-especially those procedures that include biopsy and polyp removal.Ĭolonoscopies are performed for both diagnostic and therapeutic purposes. More than two million colonoscopies are performed each year in the United States, with the majority of them performed on an outpatient basis. ![]()
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