then a single-contrast barium enema can be performed. For patients at high risk for colorectal cancer, a screening barium enema performed as an alternative to colonoscopy (G0105) is reported with code G0120. Medicare will pay for this procedure every two years (at least 23 completed months since the last screening barium enema or colonoscopy). There is no age limit. For patients at normal risk for colorectal cancer, a screening barium enema performed as an alternative to sigmoidoscopy (G0104) is reported with code G0106. Medicare will pay for this procedure every four years (at least 47 completed months since the last screening barium enema or sigmoidoscopy). The patient must be age 50 or older. If a patient chooses to have a screening barium enema but does not meet the criteria listed above, Medicare will not pay for the procedure. If the patient wants a claim submitted to Medicare in order to obtain a denial for a secondary insurance, the provider should use code G0122 (colorectal cancer screening; barium enema). This code should not be used for covered barium enema exams. Diagnosis Codes By ICD-9-CM and ICD-10-CM guidelines, the primary diagnosis code for an exam performed to screen for cancer should be a screening code—for example, code V76.51 (special screening for malignant neoplasms; colon) in ICD-9-CM or code Z12.11 (encounter for screening for malignant neoplasm of colon) in ICD-10-CM. High-risk patients will require an additional diagnosis code to reflect the specific risk factor. It is important to capture this information so that the Medicare contractor can apply the correct frequency guidelines. The Medicare Benefit Policy Manual (see the link in the Resources section) contains a list of ICD-9-CM codes for high-risk diagnoses but also states that Medicare contractors may identify additional codes that will be covered as high risk. 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. Individual Medicare contractors and non-Medicare payors may have specific preferences for diagnosis code assignment, so it is important to review any relevant published payor guidelines before submitting claims. ■ Jackie Miller, RHIA, CCS-O, CC, PCS, is vice president of product development at Coding Strategies, Inc. 30 HBMA BILLING • JULY.AUGUST.2014 Resources For Medicare coverage guidelines for colorectal cancer screening, see the Medicare Benefit Policy Manual, chapter 15, section 280.2: http://www.cms.gov/Regulations-and- Guidance/Guidance/ Manuals/Downloads/bp102c15.pdf For information on billing and reimbursement for colorectal cancer screening, see the Medicare Claims Processing Manual, chapter 18, section 60: http://www.cms.gov/ Regulations-and-Guidance/Guidance/Manuals/Downloads/ clm104c18.pdf “MLN Matters” article SE0746 discusses code assignment for a screening colonoscopy that results in a polypectomy: http://www.cms.gov/Outreach-and-Education/Medicare- Learning-Network-MLN/MLNMattersArticles/ downloads/se0746.pdf For other information about Medicare preventive services, see: http://www.cms.gov/Medicare/Prevention/Prevntion- GenInfo/ProviderResources.html Are You Following Us? Join us on Facebook, Twitter, YouTube, and LinkedIn. Go to the HBMA homepage to get connected. • Follow news and views • Find out what’s new with the association • Post comments about conferences, distance learning, or news • Retweet HBMA posts on Twitter • Like, comment, and share HBMA Facebook posts • Like, comment, and share YouTube videos • Network with other members and colleagues • Join discussions and ask questions www.hbma.org
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