How To Use HCPCS Code G0120

HCPCS code G0120 describes a specific procedure used for colorectal cancer screening. This code is an alternative to G0105, which represents a screening colonoscopy. G0120 specifically refers to a screening performed using a barium enema. In this article, we will explore the details of HCPCS code G0120, including its official description, procedure, usage guidelines, billing requirements, historical information, and coverage by Medicare and other insurance providers.

1. What is HCPCS G0120?

HCPCS code G0120 is used to identify a colorectal cancer screening procedure that involves the use of a barium enema. This screening method is an alternative to a screening colonoscopy, represented by code G0105. It is important to note that G0120 is specifically used for patients who require a barium enema for their colorectal cancer screening.

2. Official Description

The official description of HCPCS code G0120 is “Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema.” The short description for this code is “Colon ca scrn; barium enema.” These descriptions accurately represent the purpose and nature of the procedure.

3. Procedure

1. The provider begins by preparing the patient for the barium enema procedure.
2. A contrast medium, typically barium sulfate, is introduced into the patient’s rectum through a small tube.
3. An X-ray machine is used to capture images of the colon as the contrast medium flows through it.
4. The images obtained help in the detection of any abnormalities or signs of colorectal cancer.
5. After the procedure, the patient may be advised to drink plenty of fluids to help eliminate the barium from their system.

4. When to use HCPCS code G0120

HCPCS code G0120 should be used when a healthcare provider performs a colorectal cancer screening using a barium enema as an alternative to a screening colonoscopy. 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 G0120, healthcare providers need to document the following information:

• Medical necessity for the screening procedure
• Results of the screening, including any abnormalities or findings
• Documentation of the use of a barium enema
• Any additional relevant information supporting the need for this specific screening method

Providers should also ensure that they follow the specific billing guidelines and requirements set by Medicare or other insurance providers to ensure proper reimbursement.

6. Historical Information and Code Maintenance

HCPCS code G0120 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

Medicare and other insurance providers may cover the colorectal cancer screening procedure represented by HCPCS code G0120. 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 this code is not applicable as HCPCS priced under one methodology.

8. Examples

Here are five examples of scenarios where HCPCS code G0120 should be billed:

1. A patient with a family history of colorectal cancer undergoes a barium enema screening as an alternative to a colonoscopy.
2. An elderly patient who cannot tolerate a colonoscopy due to medical reasons opts for a barium enema screening.
3. A patient with a previous history of polyps undergoes a regular barium enema screening to monitor any potential recurrence.
4. A healthcare provider performs a barium enema screening for a patient who is unable to undergo sedation required for a colonoscopy.
5. A patient with a known allergy to the anesthesia used during a colonoscopy chooses a barium enema screening instead.