Monday, July 19, 2010

Colonoscopy and Sigmoidoscopy - applicable CPT's and ICD's?

What are the applicable CPT's and ICD's?

CPT's to report Colonoscopy and Sigmoidoscopy


G0104 Colorectal cancer screening; flexible sigmoidoscopy
G0105 Colorectal cancer screening; colonoscopy on individual at high risk
G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
G0106 Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema
G0120 Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema
45330-45345 Sigmoidoscopy Services
45378-45392 Colonoscopy Services

ICD-9 Codes that Support Medical Necessity almost for all insurances

V76.41 Screening for malignant neoplasm of the rectum
V76.51 Screening for malignant neoplasm, colon
V67.09 Follow-up examination following other surgery
V10.0 Personal history of malignant neoplasm of unspecified site in gastrointestinal tract
V10.05 Personal history of malignant neoplasm of large intestine
V10.06 Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus
V12.72 Personal history of colonic polyps
V16.0 Family history of malignant neoplasm of gastrointestinal tract
211.3 Benign neoplasm of colon
211.4 Benign neoplasm rectum and anal canal
235.2 Neoplasm of uncertain behavior of stomach, intestines, and rectum
569.0 Anal and Rectal Polyp

Preventive benefits are applied to screening colonoscopies or flexible sigmoidoscopies (G-codes when reported with a screening diagnosis V-code); non-preventive benefits are applied for colonoscopies or flexible sigmoidoscopies reported with diagnosis codes for specific illnesses, signs or symptoms. It is important to assign the correct ICD-9-CM diagnosis to the procedures as per the Local Coverage Determinations applicable in CMS http://www.cms.hhs.gov/mcd/search.asp

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Most read colonoscopy CPT codes