How To Use HCPCS Code G0106

HCPCS code G0106 describes a specific procedure used for colorectal cancer screening. This code is an alternative to G0104, which represents screening sigmoidoscopy. The procedure associated with G0106 involves a barium enema, which is a diagnostic radiology service. In this article, we will explore the details of HCPCS code G0106, 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 G0106?

HCPCS code G0106 is used to identify a specific procedure for colorectal cancer screening. It is an alternative to G0104, which represents screening sigmoidoscopy. The procedure associated with G0106 involves a barium enema, which is a diagnostic radiology service. This code is used to accurately document and bill for this particular screening procedure.

2. Official Description

The official description of HCPCS code G0106 is “Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema.” The short description is “Colon ca screen; barium enema.” These descriptions provide a concise summary of the procedure and its purpose.

3. Procedure

1. The provider prepares the patient for the barium enema procedure.
2. A contrast medium, typically barium sulfate, is introduced into the patient’s rectum through a tube.
3. An X-ray machine is used to capture images of the colon and rectum as the contrast medium flows through the digestive system.
4. The images obtained are carefully examined by a radiologist to detect any abnormalities or signs of colorectal cancer.
5. The results of the screening are documented and communicated to the patient.

4. When to use HCPCS code G0106

HCPCS code G0106 should be used when performing a colorectal cancer screening using a barium enema instead of a screening sigmoidoscopy (G0104). It is important to follow the specific guidelines and eligibility criteria set by Medicare or other insurance providers to ensure accurate billing and reimbursement.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code G0106, healthcare providers need to document the details of the procedure, including the patient’s medical history, the specific indications for the screening, and the results obtained. It is essential to include all relevant information in the medical record to support the medical necessity of the procedure and ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0106 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. This code has remained unchanged since its inception.

7. Medicare and Insurance Coverage

HCPCS code G0106 is covered by Medicare and other insurance providers. The pricing indicator code 11 indicates that the price for this service is established using national RVUs (Relative Value Units). The multiple pricing indicator code A signifies that the code is not applicable as HCPCS priced under one methodology. It is important to verify coverage and reimbursement policies with the specific insurance provider to ensure accurate billing and reimbursement.

8. Examples

Here are five examples of when HCPCS code G0106 should be billed:

1. A 55-year-old patient with a family history of colorectal cancer undergoes a barium enema screening as part of their routine preventive care.
2. A 60-year-old patient presents with symptoms suggestive of colorectal cancer and undergoes a barium enema screening to evaluate the presence of any abnormalities.
3. A 70-year-old patient with a previous history of polyps undergoes a barium enema screening to monitor the recurrence or development of any new polyps.
4. A 45-year-old patient with a genetic predisposition to colorectal cancer undergoes a barium enema screening as recommended by their healthcare provider.
5. A 50-year-old patient who is unable to undergo a screening sigmoidoscopy due to medical reasons opts for a barium enema screening instead.