Colonoscopy screening. The question is, “Doctor sees the patient in the office for screening colonoscopy.” So they’re like, “Is it V76.51 or V76.59?” “The doctor spends about 15 minutes with the patient and then we go in and spend another 10 minutes explaining prep to them and signing consent. So they’re upset. Now Medicare wants you not to be paid for the office visit? Is there a special code to use? Give the secret. How do I get that office visit paid?”
Colonoscopy Screening Medical Coding Video
So, you may not like my answer, but this is what our research showed. And you know, basically, we do these answer sheets. They’re like a scratch pad. It’s you know, what we encourage you to do to be your own you know, researcher. And I used to do a session on that local AAPC chapters on how to be your own consultant. Maybe I should bring that back and show people how to look up things like this.
So at any rate, colonoscopy screening. We need to look up these 2 codes that she referenced. V76.51 says screening for malignant neoplasm of the colon or it could be screening colonoscopy not otherwise specified. V76.49 is screening for malignant neoplasms other sites. So the answer, because she said it was a colonoscopy, is going to be V76.51. And if it’s high risk then it’s going to be V16.0 and that needs to be your lead code because that tells Medicare, right off the bat, that it’s a screening. And I know some of you are probably saying, “Well, doesn’t the procedure tell them that it’s a screening?” Yes but they use different fields to do particular edits. So in this case, they’re using the diagnostic field to do that. So when you do these screening colonoscopies, always lead with the V code.
Now I found some resources for you. MLN – Medicare Learning Network has great articles on things like this when you get stuck. So I recommend you go check this out. I can show you real quick. It looks like this. It’s a little more casual compared to some of their other types of documents but colorectal cancer, preventable, treatable and beatable, medicare-covered and billing for colorectal cancer screening. So if you are getting denied for something that you feel you should get paid for, these are great to reference in an appeal letter.
So you know, just kind of read through this and I did grab a piece of this. Where is it? Down here, this chart here: How To Bill Medicare and these are the codes that they want us to use when you’re billing Medicare for cancer screening. So G0104 is for when you do a to check that. 105 – colonoscopy on an individual at high risk so that should match up with that high risk V code. 106 is colon cancer screening when they use barium enema as an alternative to doing the flex sig. G0107* is FOBT 1-3 simultaneous determinations. That’s Fecal Occult Blood Test and the 1-3 simultaneous determinations are the little cards where they do the smear. So they do that 3 times. 120 – barium enema as an alternative to 105. So instead of the high risk one, they’re doing the barium enema one. 121 – colonoscopy for individuals not needing criteria for high risk. 122 – colon cancer screening barium enema, non-covered. So this is where you’re doing the colonoscopy. You know the patient doesn’t have any diagnoses or maybe it’s too frequent since the last time they had one, it’s not going to be covered. You have the patient sign the waiver but you still need to report to Medicare that it was done. The G0328, this is as an alternative to 107 using the Fecal Occult Blood Test. So a lot of choices for this particular procedure. So keep that in mind, those are all the different G codes for Medicare and I have this in the handouts.
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