Preventive healthcare: Colorectal screenings

March 1st, 2020 / By Karla VonEschen, CPC, CPMA

At this point in my life, many individuals I know have been touched by cancer in one way or another. Since March is colorectal cancer month, this seemed like an appropriate blog topic. The American Cancer Society states, “In the United States, colorectal cancer is the third leading cause of cancer-related deaths in men and women, and the second most common cause of cancer deaths when men and women are combined. Colorectal cancer is expected to cause about 53,200 deaths during 2020.” 

What is Colorectal Cancer (CRC)?

The definition of CRC is unchecked division and survival of abnormal cells in the colon or rectum. According to the American Cancer Society, CRC typically starts as a non-cancerous growth, also known as a polyp in the inner lining of the colon or rectum and grows slowly over a period of 10-20 years.

Statistics

This year alone, it is estimated that more than 104,000 new cases of CRC and 43,000 new cases of rectal cancer will be diagnosed in the United States. Here are some additional statistics on CRC:

  • Non-Hispanic Black men and women have the highest rate of diagnosis and mortality
  • Asian or Pacific Islanders have the lowest instance of diagnosis and mortality
  • Men are more at risk of being diagnosed at 4.6 percent (1 in 22) than women at 4.2 percent (1 in 24)
  • Aging increases our risk. The median age of diagnosis is 68 years for men and 72 for women

One aspect of CRC I found interesting was the geographical difference in occurrence. The pattern of CRC has changed drastically over the past few decades, with the Northeast United States seeing the highest rate of occurrence and the South seeing the lowest in the 1970s and 1980s. More recently, people in Western states, such as Washington, Colorado and New Mexico, have the lowest incidence of CRC, while Southern states such as Louisiana, Alabama and Kentucky have higher rates. Mortality rates run about the same, but the South has the highest mortality from CRC.  

Prevention with screenings is pivotal  to early detection and treatment. For those of us who code, correct coding is also an essential piece for tracking and appropriate payment. Physicians must make sure documentation indicates the patient is having a “screening” colonoscopy.  Here are some of the more common codes used for colon and rectal related procedures:

ICD-10-CM

Z12.11

Encounter for screening for malignant neoplasm of colon

Z80.0

Family history of malignant neoplasm of digestive organs (high risk)

Z86.010

Personal history of benign neoplasm (high risk)

Z85.038

Personal history of other malignant neoplasm of large intestine (high risk)

Z85.048

Personal history of other malignant neoplasm of rectum, rectosigmoid junction, and anus (high risk)

 

CPT

45378

Colonoscopy

45379

Colonoscopy, with removal of foreign body

45380

Colonoscopy, with biopsy, single or multiple

G0105

Colorectal cancer screening; colonoscopy on individual at high risk (Medicare)

G0121

Colorectal cancer screening; colonoscopy on individual not meeting the criteria for high risk (Medicare)

 

The above lists are not all-inclusive, so review the physician documentation carefully and refer to your coding books for the appropriate ICD-10, CPT, or HCPC codes, as well as the guidelines for billing and sequencing.

It’s essential to keep in mind that not all payers accept HCPCS Level II codes. Level II HCPC codes were initially intended for Medicare claims, but many private payers have now adopted the HCPCS Level II code set. When a CPT code and HCPCS Level II code exist for the same service or procedure, Medicare will usually require providers to report the HCPCS Level II code. Some third-party payers follow Medicare guidelines, but you must check with your payers before submission.

Although it seems like this disease is everywhere, in January 2020 the American Cancer Society indicated cancer rates dropped by 29 percent between 1991 and 2017, including a 2.2 percent drop from 2016 to 2017. The decrease in cancer diagnosis is excellent news for all of us and can most likely be attributed to regular screenings.

This year I hit the age when it was finally time to have my first colonoscopy. I admit the preparation wasn’t fun, but the procedure was easy. By the time I left the surgical center, I had peace of mind that I was healthy and the good fortune not to have the procedure done for another ten years!

So, while you start thinking about preparing for spring and summer, consider adding preventive health services to your list.

Karla VonEschen is a coding analyst at 3M Health Information Systems.


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Resources:

American Cancer Society- https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2017-2019.pdf

https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html

https://www.cancer.org/latest-news/facts-and-figures-2020.html