How To Use HCPCS Code G0105

HCPCS code G0105 describes a specific procedure used for colorectal cancer screening in individuals who are at high risk. This code is used to identify and bill for a colonoscopy performed on patients who have an increased likelihood of developing colorectal cancer. In this article, we will explore the details of HCPCS code G0105, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS G0105?

HCPCS code G0105 is used to identify a specific procedure known as colorectal cancer screening colonoscopy on an individual who is at high risk. This code is essential for medical coders and billers to accurately document and bill for this particular service.

2. Official Description

The official description of HCPCS code G0105 is “Colorectal cancer screening; colonoscopy on individual at high risk.” The short description is “Colorectal scrn; hi risk ind.” These descriptions provide a clear understanding of the purpose and scope of this code.

3. Procedure

1. Preparation: The patient is required to undergo specific preparations before the colonoscopy, which may include dietary restrictions and bowel cleansing.
2. Anesthesia: The patient may receive anesthesia to ensure their comfort during the procedure.
3. Insertion of Colonoscope: The healthcare provider inserts a colonoscope, a long, flexible tube with a camera, into the patient’s rectum and advances it through the colon.
4. Visualization and Examination: The provider carefully examines the colon’s lining using the camera attached to the colonoscope. They look for any abnormalities, such as polyps or tumors.
5. Biopsy or Polyp Removal: If any suspicious areas or polyps are found, the provider may perform a biopsy or remove the polyps for further examination.
6. Withdrawal of Colonoscope: Once the examination is complete, the provider slowly withdraws the colonoscope while examining the colon’s lining.
7. Recovery and Follow-up: After the procedure, the patient is monitored in a recovery area until the effects of anesthesia wear off. The provider may discuss the findings and recommend any necessary follow-up care.

4. When to use HCPCS code G0105

HCPCS code G0105 should be used when performing a colorectal cancer screening colonoscopy on an individual who is at high risk. High-risk individuals may include those with a family history of colorectal cancer, a personal history of polyps or colorectal cancer, or certain genetic conditions that increase the risk of developing colorectal cancer. It is important to review the specific guidelines and criteria set by Medicare or other insurance providers to ensure accurate usage of this code.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0105, healthcare providers need to document the medical necessity of the procedure, including the patient’s high-risk status and any relevant medical history. It is crucial to include detailed documentation of the procedure itself, including the findings, any biopsies or polyp removals performed, and any complications encountered. Additionally, providers should ensure that the documentation supports the medical necessity of the screening colonoscopy for a high-risk individual.

6. Historical Information and Code Maintenance

HCPCS code G0105 was added to the Healthcare Common Procedure Coding System on January 01, 1998. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code. It is important to stay updated with any changes or revisions to the code to ensure accurate coding and billing.

7. Medicare and Insurance Coverage

Medicare and other insurance providers typically provide coverage for colorectal cancer screening colonoscopies for individuals at high risk. The pricing indicator code 11 indicates that the price for this service is established using national Relative Value Units (RVUs). The multiple pricing indicator code A signifies that the code is not applicable as HCPCS priced under one methodology. However, it is essential to verify the specific coverage and reimbursement policies of each insurance provider to ensure accurate billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G0105 should be billed:

1. A 55-year-old patient with a family history of colorectal cancer undergoes a screening colonoscopy to detect any early signs of the disease.
2. A 40-year-old patient with a personal history of colorectal polyps undergoes a follow-up screening colonoscopy to monitor for any recurrence or new polyps.
3. A 30-year-old patient with a genetic condition associated with an increased risk of colorectal cancer undergoes a screening colonoscopy as part of their regular surveillance.
4. A 60-year-old patient with a history of inflammatory bowel disease undergoes a screening colonoscopy to monitor for any development of colorectal cancer.
5. A 50-year-old patient with no personal or family history of colorectal cancer undergoes a screening colonoscopy as part of routine preventive care.