Coding Consult

July 21, 2006

Answers to your questions about... patient-supplied B12; screening colonoscopies; rest home/NF codes

Patient-supplied B-12

Q. I have patients who fill their scripts for vitamin B-12, then bring in the vials to the office, and I administer the injections. How do I code this service?

Screening colonoscopies

Q. I filed a claim for a screening colonoscopy for a Medicare patient, but the claim was denied. Doesn't Medicare cover these screenings?

A. Yes, but only under certain well-defined circumstances.

For patients over 50 who aren't considered at high risk for developing colorectal cancer, Medicare covers a screening colonoscopy once every 10 years. The appropriate HCPS code is G0121 (colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk). If the patient has had a screening flexible sigmoidoscopy, you have to wait 47 months before Medicare will cover a screening colonoscopy.

For patients who are at high risk, Medicare covers screening colonoscopies every two years, regardless of age. Use G0105 (colorectal cancer screening; colonoscopy on individual at high risk).

The diagnosis must justify the procedure code. For G0105, approved codes include:

Additional approved diagnoses for G0105 include inflammatory bowel disease, Crohn's disease or ulcerative colitis. For patients not at high risk, the most common approved code is V76.51 (special screening for malignant neoplasms; intestine; colon).

Rest home/NF codes

Q. Should I use the same codes when I perform an E&M service on a rest home patient as I would if the patient were in a nursing facility?

A. No. When you treat a rest home patient, use domiciliary, rest home, or custodial care service codes. For a new patient, use 99324-99328 and report established patient visits with 99334-99337.

Claim NF services with 99304-99318. Initial care codes are 99304-99306, and subsequent care codes are 99307-99310. There are also NF codes for discharge (99315-99316) and annual assessment services (99318).

Remember to use different place-of-service codes. CPT classifies rest home, domiciliary, and custodial care facilities as POS 33 (custodial care facility). For claims involving NF care, use POS 32 (nursing facility).

This information is adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples, FL 34112; phone 800-508-2582; fax 800-508-2592 or visit http://www.codinginstitute.com