In the United States Colorectal cancer is the second most lethal type of cancer. In 2017, it’s estimated there will be 135,430 new cases and 50,260 deaths from colon and rectal cancers.
Colon cancer screening could prevent many of these deaths, as a patient’s prognosis improves dramatically with early detection and treatment. Tests that are designed to detect both early cancer and adenomatous polyps should be encouraged if resources are available and patients are willing to undergo an invasive test.
Colorectal Cancer Facts from fightingcolorectalcancer.org:
- 1 in 20 people will be diagnosed with colorectal cancer.
- 1 in 3 people are not up-to-date with colorectal cancer screening.
- 23 million people have not been screened for colorectal cancer.
- 60% of colorectal cancer deaths could be prevented with screening.
- 25% of people diagnosed with colorectal cancer have a family history.
The U.S. Preventive Services Task Force recommends that adults age 50 to 75 be screened for colorectal cancer. The decision to be screened after age 75 should be made on an individual basis. If you are older than 75, ask your doctor if you should be screened. People at higher risk of developing colorectal cancer should begin screening at a younger age, and may need to be tested more frequently.
A screening colonoscopy should be reported with the following International Classification of Diseases, 10th edition (ICD-10) codes:
· Z12.11: Encounter for screening for malignant neoplasm of the colon
· Z80.0: Family history of malignant neoplasm of digestive organs
· Z86.010: Personal history of colonic polyps
Flexible Sigmoidoscopy (Typically every 4-5 years)
Fecal Occult Blood test (FOBT) (Annually) – Most Medicare patients prefer this over all other options
Fecal Immunochemical test (FIT) (Annually)
A screening is a service performed in the absence of signs or symptoms. Once the patient has a diagnosis of polyps, whether a sessile serrated adenoma (SSA), adenoma or hyperplastic, follow-up colonoscopies are surveillance, not screening.
If the patient has a history of polyps, returns for a follow-up exam and is otherwise asymptomatic, then the exam is a surveillance colonoscopy. If the previous polyps were benign, then code Z86.010 (Personal history of colonic polyps) should be reported.
For Medicare beneficiaries, report screening colonoscopy HCPCS code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) or G0121 (Colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk).
According to Medicare Learning Network Matters Medicare Coverage and Billing for Colorectal Cancer Screening, Medicare beneficiaries without high risk factors are eligible for screening colonoscopy every ten years. Beneficiaries at high risk for developing colorectal cancer are eligible once every 24 months. Medicare considers an individual high risk for developing colorectal cancer if they have one or more of the following:
· Close relative (sibling, parent or child) who has had colorectal cancer or an adenomatous polyp.
· Family history of familial adenomatous polyposis.
· Family history of hereditary nonpolyposis colorectal cancer.
· Personal history of adenomatous polyps.
· Personal history of colorectal cancer.
· IBD, including Crohn’s disease, and ulcerative colitis.
To report screening colonoscopy on a patient not considered high risk for colorectal cancer, use HCPCS code G0121 and Z12.11 (Encounter for screening for malignant neoplasm of colon) or Z12.12 (Encounter for screening for malignant neoplasm of rectum) as appropriate. To report screening on a Medicare beneficiary at high risk for colorectal cancer, use HCPCS G0105 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk) and the appropriate diagnosis code that necessitates the more frequent screening
American Gastroenterological Association (www.gastro.org)
American Family Physicians