Wednesday, October 28, 2015

Coding Information for Colorectal Cancer Screening CPT codes and covered DX

CPT/HCPCS Codes
Group 1 Paragraph
G0122 Colorectal cancer screening; barium enema (non-covered)

Group 1 Codes
82270 Occult blood feces
G0104 CA screen;flexi sigmoidscope
G0105 Colorectal scrn; hi risk ind
G0106 Colon CA screen;barium enema
G0120 Colon ca scrn; barium enema
G0121 Colon ca scrn not hi rsk ind
G0122 Colon ca scrn; barium enema
G0328 Fecal blood scrn immunoassay
G0464 Colorec CA scr, sto bas DNA


ICD-9 Codes that Support Medical Necessity

Group 1 Paragraph
The following diagnosis list applies only to procedure codes G0105 (Screening Colonoscopy) and G0120 (Barium Enema)

Group 1 Codes
555.0 REGIONAL ENTERITIS OF SMALL INTESTINE
555.1 REGIONAL ENTERITIS OF LARGE INTESTINE
555.2 REGIONAL ENTERITIS OF SMALL INTESTINE WITH LARGE INTESTINE
555.9 REGIONAL ENTERITIS OF UNSPECIFIED SITE
556.0 ULCERATIVE (CHRONIC) ENTEROCOLITIS
556.1 ULCERATIVE (CHRONIC) ILEOCOLITIS
556.2 ULCERATIVE (CHRONIC) PROCTITIS
556.3 ULCERATIVE (CHRONIC) PROCTOSIGMOIDITIS
556.4 PSEUDOPOLYPOSIS OF COLON
556.5 LEFT-SIDED ULCERATIVE (CHRONIC) COLITIS
556.6 UNIVERSAL ULCERATIVE (CHRONIC) COLITIS
556.8 OTHER ULCERATIVE COLITIS
556.9 ULCERATIVE COLITIS UNSPECIFIED
558.1 GASTROENTERITIS AND COLITIS DUE TO RADIATION
558.2 TOXIC GASTROENTERITIS AND COLITIS
558.3 ALLERGIC GASTROENTERITIS AND COLITIS
558.41 EOSINOPHILIC GASTROENTERITIS
558.42 EOSINOPHILIC COLITIS
558.9 OTHER AND UNSPECIFIED NONINFECTIOUS GASTROENTERITIS AND COLITIS
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
V18.51 FAMILY HISTORY, COLONIC POLYPS
V18.59 FAMILY HISTORY, OTHER DIGESTIVE DISORDERS
V76.41 SCREENING FOR MALIGNANT NEOPLASMS OF THE RECTUM
V76.51 SPECIAL SCREENING FOR MALIGNANT NEOPLASMS COLON
ICD-9 Codes that DO NOT Support Medical Necessity
N/A
ICD-10 Codes that Support Medical Necessity
N/A
ICD-10 Codes that DO NOT Support Medical Necessity
N/A

Documentation Requirements

Medical record documentation maintained by the provider must indicate that the service provided was screening in nature. In addition, if procedure code G0105 (Screening colonoscopy) or G0120 (Barium enema) is billed, the documentation should support that the patient is at high risk. This information is usually found in the office/progress notes, history/physical, and/or procedure note.

The patient's medical record should contain documentation to support an incomplete procedure.

Utilization Guidelines

It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.

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