The Best Choice for Colon Cancer Study is G0121

The Best Choice for Colon Cancer Study is G0121

If you are coding for colorectal cancer screening and disturbed about the fact that your payer won't accept them, your protection could lie on the following frequency guidelines and eligibility requirements exactly as instructed. These four facts could have the coding answers you are looking for:

Average risk patients qualify for colorectal cancer test Average risk patients are those patients who are at least 50 years old and are eligible for a covered Medicare screening. These patients can have a colon cancer screening only once every 10 years. Remember that it's once in 10 years or nothing to most payers never more. You shouldn't ignore these frequency guidelines because if you do so, it could spell trouble.

Just one ICD-9 links to G0121 So long as there's no requirement for any therapeutic intervention during the colonoscopy, payers need just one diagnosis code on all G0121 claims: V76.51. But, you can link secondary diagnosis, for example diverticulosis (562.10) or hemorrhoids (455.0). Remember to always list the V codes for an average risk screening.

Flex sigmoidoscopy limits screening eligibility Depending on what other related colorectal cancer tests you performed on a patient prior to this, frequency rules are different. For example, if a patient has had a routine flexible sigmoidoscopy screening, he's not entitled to a screening colonoscopy for at least 48 months.

45378 works for some private carriers While many private payers accept the G codes for colorectal cancer screening, some non-Medicare payers prefer 45378 for a screening colonoscopy. As a general rule, you should look for the private payer's frequency and diagnosis guidelines, which might differ from Medicare's, prior to coding these services. For more medical coding updates, sign up for a medical coding guidelike Supercoder!

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