Overview
This lecture covers colonoscopy coding, focusing on documentation, code selection, and key differences between screening and diagnostic procedures, with attention to current guidelines and common coding practices.
Colonoscopy Intent & Setting
- Colonoscopies are primarily performed in Ambulatory Surgery Centers (ASCs) or hospitals.
- Guidelines and documentation may differ slightly between ASCs and hospitals but are largely similar.
- Always determine the intent of the colonoscopy: screening (preventative) vs diagnostic (symptoms present).
Screening vs Diagnostic Colonoscopies
- Screening colonoscopies are typically recommended starting at age 45, earlier for high-risk individuals.
- Diagnostic colonoscopies are performed when symptoms (e.g., pain, bleeding, suspected disease) are present.
- Coding requires both a CPT/HCPCS procedure code and an ICD diagnosis code supporting the procedure's intent.
Common Codes for Colonoscopy
- ICD Codes for Screening:
- Z12.11 — Encounter for screening for malignant neoplasm of the colon.
- Z85.038 — Personal history of other malignant neoplasm of the large intestine.
- Z86.010 — Personal history of colonic polyps.
- Z80.0 — Family history of malignant neoplasm of digestive organs.
- HCPCS Codes (Medicare patients):
- G0121 — Colonoscopy, not high risk.
- G0105 — Colonoscopy, high risk.
- G0104 — Flexible sigmoidoscopy.
- CPT Codes:
- 45378 — Flexible colonoscopy, diagnostic.
- 45330 — Flexible sigmoidoscopy, diagnostic.
Conversion and Modifiers
- If a screening colonoscopy becomes diagnostic (e.g., polyps are found/removed), code as diagnostic.
- Use modifier PT (Medicare) for colorectal screening converted to diagnostic, modifier 33 (commercial payers) for preventive services.
Colonoscopic Removal Techniques & Coding
- Use separate codes for different removal techniques (e.g., hot biopsy vs snare).
- 45384 — Removal with hot biopsy forceps.
- 45385 — Removal with snare technique.
- Verbiage clues: "hot biopsy" for 45384; "snare loop," "in block," "piecemeal" for 45385.
- Use multiple codes if multiple techniques are used in one procedure.
Other Common Colonoscopy CPT Codes
- 45380 — With biopsy, single or multiple.
- 45381 — With directed submucosal injection (e.g., tattooing).
- 45382 — With control of bleeding, any method.
- 45388 — With ablation of tumor.
- 45390 — With endoscopic mucosal resection.
Documentation & Coding Tips
- Always code to the intended extent of the procedure if incomplete; use modifiers for incomplete procedures.
- Use BAT (Bubble-Highlight-Annotation) technique for marking key code descriptions in your CPT manual for faster, more accurate coding.
- Z-codes indicating reason for encounter are usually sequenced first if they explain why the procedure is performed.
- For suboptimal prep, consider code Z91.19.
Key Terms & Definitions
- Screening Colonoscopy — Done to detect disease in asymptomatic patients.
- Diagnostic Colonoscopy — Performed to investigate symptoms or findings.
- Modifier PT — Indicates colorectal cancer screening converted to diagnostic for Medicare.
- Modifier 33 — Preventive services for most commercial payers.
- BAT Technique — Bubble, highlight, annotate in CPT manual for clarity.
Action Items / Next Steps
- Review appropriate use of modifiers PT and 33.
- Verify and memorize the most common colonoscopy and removal CPT/HCPCS/ICD codes.
- Practice using the BAT technique on CPT codes relevant to GI/endoscopy procedures.
- Check payer policies for screening age and high-risk definitions.