![]() Reportable procedure and diagnoses include: The patient is eligible for a screening colonoscopy. The patient has no history of polyps and none of the patient’s siblings, parents or children has a history of polyps or colon cancer. The patient has never had a screening colonoscopy. Read also: Osteoarthritis ICD 10 coding tips for codersĪ 52-year-old patient calls the surgeon’s office and requests a screening colonoscopy. G0121 Colorectal cancer screening colonoscopy on individual not meeting criteria for high risk G0105 Colorectal cancer screening colonoscopy on individual at high risk Placement of decompression tube, when performedĤ5398 Colonoscopy, flexible with band ligation(s) (eg, hemorrhoids) ![]() Read also: Coding guide for lymph node biopsy for codersĤ5379 Colonoscopy, flexible with removal of foreign body(s)Ĥ5380 Colonoscopy, flexible with biopsy, single or multipleĤ5381 Colonoscopy, flexible with directed submucosal injection(s), any substanceĤ5382 Colonoscopy, flexible with control of bleeding, any methodĤ5388 Colonoscopy, flexible with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and postdilation and guide wire passage, when performed)Ĥ5384 Colonoscopy, flexible with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forcepsĤ5385 Colonoscopy, flexible with removal of tumor(s), polyp(s), or other lesion(s) by snare techniqueĤ5386 Colonoscopy, flexible with transendoscopic balloon dilationĤ5389 Colonoscopy, flexible with endoscopic stent placement (includes pre- and postdilation and guide wire passage, when performed)Ĥ5391 Colonoscopy, flexible with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structuresĤ5392 Colonoscopy, flexible with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s), includes endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structuresĤ5390 Colonoscopy, flexible with endoscopic mucosal resectionĤ5393 Colonoscopy, flexible with decompression (for pathologic distention) (eg, volvulus, megacolon), including A sigmoidoscope (an endoscope typically 65 centimeters in length) may be used for a colonoscopy only if the bowel is sufficiently short so that the entire colon may be examined, and such should be clearly documented in the clinical record. Beginning January 1, 2016, Medicare will pay for the interrupted colonoscopy at a rate that is calculated using one-half the value of the inputs for the codes.ĭo not report a colonoscopy procedure code for an endoscopy performed with a sigmoidoscope on a patient with a normal length colon, even if the sigmoidoscope reaches proximal to the splenic flexure. ![]() An incomplete colonoscopy performed prior to January 1, 2016, is paid at the same rate as a sigmoidoscopy. A patient with rectal bleeding and anemia who is has a colonscopy is having a diagnostic colonoscopy.Īn incomplete colonoscopy, e.g., the inability to advance the colonoscope to the cecum or colon-small intestine anastomosis due to unforeseen circumstances, is billed and paid using colonoscopy through stoma code 44388, colonoscopy code 45378, and screening colonoscopy codes G0105 and G0121 with modifier “-53.” (Code 44388 is valid with modifier 53 beginning January 1, 2016.) The Medicare physician fee schedule database has specific values for codes 44388-53, 45378-53, G0105-53 and G0121-53. ![]() A diagnostic test is done in response to a sign or symptom, to investigate and diagnosis a condition. Screening Colonoscopy describes as it is routinely performed on an asymptomatic person for the purpose of testing for the presence of colorectal cancer or colorectal polyps. Patients can begin screening for colorectal cancer (CRC)at 45, without being charged a copay or deductible.Ĥ5378 Colonoscopy, flexible diagnostic, including collection of specimen(s) by brushing or washing, when performed ( separate procedure) The 2023 Physician Fee Schedule rule released on 11/1/22 and as per the new update CMS is lowering the age for screening from 50 to 45. CPT code 45378 is one of the procedure code used for reporting colonoscopy.ĭescription of CPT code 45378 (colonoscopy) Colonoscopy is the most effective diagnostic procedure for colon polyps and early colorectal cancer. Colonoscopy is an examination of the entire colon, from the rectum to the cecum, and may include examination of the terminal ileum or small intestine proximal to an anastomosis.
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