CODING CORNER • A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp • A family history of familial adenomatous polyposis • A family history of hereditary nonpolyposis colorectal cancer • A personal history of adenomatous polyps • A personal history of colorectal cancer • A personal history of inflammatory bowel disease, including Crohn’s disease and ulcerative colitis Screening Colonoscopy Screening colonoscopy is the most effective way to detect colorectal cancer and precancerous polyps. However, it is also Findings of the exam should be reported as a secondary diagnosis. For example, if a screening reveals an abnormality like a polyp or diverticulosis, the screening code should be reported first, followed by the code for the finding and the code for the high-risk condition, if applicable. relatively costly and requires a strenuous prep, moderate sedation, and – if the patient is employed – time away from work. Screening colonoscopy is reported with the following HCPCS codes, depending on whether the patient has any of the high-risk criteria listed previously: • G0105: Colorectal cancer screening; colonoscopy on individual at high risk • G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk A screening colonoscopy must be performed by a physician. There is no minimum age for coverage. If the physician performs a biopsy or lesion removal during a screening colonoscopy, the procedure should be reported as a diagnostic colonoscopy using the appropriate CPT code. For patients at high risk of colorectal cancer, Medicare will cover screening colonoscopy (G0105) once every two years. At least 23 months must have passed since the month in which the previous screening colonoscopy was performed. For patients at normal risk of colorectal cancer, Medicare will cover screening colonoscopy (G0121) once every 10 years (at least 119 completed months since the last colonoscopy). If a normal-risk patient’s prior screening was a sigmoidoscopy rather than a colonoscopy, then only four years (47 completed months) must elapse before the patient is eligible for coverage of a screening colonoscopy. Barium Enema A barium enema is a fluoroscopic exam of the colon performed by instilling barium sulfate into the rectum. For a double-contrast barium enema, also called an air-contrast barium enema, air is also pumped into the colon to distend it and make abnormalities easier to see. A barium enema is not an optimal test for cancer screening since small lesions can be easily missed. However, Medicare will cover screening barium enemas under limited circumstances. The exam is reported with the following HCPCS codes: • G0106: Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema • G0120: Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema The screening barium enema must be ordered in writing by a physician after determining that the procedure is appropriate. Specifically, the physician must establish that the estimated screening potential for a barium enema exam of the patient in question is equal to or greater than the screening potential for a screening sigmoidoscopy or colonoscopy of the same patient. The Medicare Benefit Policy Manual (chapter 15, section 280.2.2.E) states, “Generally, it is expected that this will be a screening double contrast enema unless the individual is unable to withstand such an exam.” If the patient is unable to undergo a double-contrast barium enema, THE JOURNAL OF THE HEALTHCARE BILLING AND MANAGEMENT ASSOCIATION 29
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