National Colorectal Cancer Awareness Month: Understanding Cancer Diagnosis Codes

Colorectal cancer, is the third most common cancer in the world. And in the United States, it is the second leading cause of cancer-related deaths among men and women combined. However, colorectal cancer is treatable if detected early. Therefore, every March, National Colorectal Cancer Awareness Month is observed to raise awareness about the disease and encourage people to get screened for it to understand cancer diagnosis codes.  

History behind National Colorectal Cancer Awareness Month  

National Colorectal Cancer Awareness Month was first observed in 2000 by the Colorectal Cancer Alliance, a non-profit organization dedicated to ending colorectal cancer. The goal of the awareness month is to raise awareness of the disease and encourage people to get screened for it and know all details of cancer diagnosis codes.  

Why is screening so important?  

Colorectal cancer is one of the leading causes of cancer-related deaths in the United States. However, when detected early, it is highly treatable, and the five-year survival rate is around 90%. 

Screening can detect precancerous polyps, which are abnormal growths in the colon or rectum that can turn into cancer over time. Removing these polyps during screening can prevent them from becoming cancerous. 

There are several screening tests available, and the choice of test depends on various factors, such as age, risk factors, and personal preference. Fecal occult blood testing, sigmoidoscopy, colonoscopy, and virtual colonoscopy are some of the screening tests available for cancer diagnosis codes.

Rules for Screening Services  

Medicare covers colorectal screening services for beneficiaries aged 50 and older. If the patient is at an average risk for colorectal cancer, the interval is every 10 years. If the patient is at high risk for colorectal cancer, the frequency may be more often. 

Medicare covers colorectal screening services for beneficiaries aged 50 and older. If the patient is at an average risk for colorectal cancer, the interval is every 10 years. If the patient is at high risk for colorectal cancer, the frequency may be more often. 

Patients at high risk for colon cancer generally have one or more of the following characteristics: 

• Close family member (sister, brother, parent, child) who has had colorectal cancer or an adenomatous polyp. 
  
• Family history of: 

1. Adenomatous polyposis or 
2. Hereditary nonpolyposis colorectal cancer. 

• Personal history of: 

1. Adenomatous polyps, 
2. colorectal cancer, or 
3. inflammatory bowel disease (Crohn’s disease or ulcerative colitis). 

NOTE: In the process of a screening colonoscopy service, if the provider finds something, such as a polyp, bill the appropriate diagnostic cancer diagnosis codes rather than the screening code. Payers may vary in diagnosis coding requirements in this scenario. In most cases, you should report the screening diagnosis code followed by the diagnostic code. Be sure to check the payer’s policy before billing.  

Colonoscopy CPT Codes used for screening or cancer diagnosis codes

CPT codes are used to diagnose and classify diseases and medical conditions. There are several codes used to medically code for screening and diagnosis of colorectal cancer. Here are some useful CPT Codes for screening and diagnosis regarding Cancer Diagnosis Codes. 

1. 45385: The provider examines the colon and rectum using a colonoscope, a long, thin flexible tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions with a snare, a wire loop that he passes around the base of the lesion and tightens it until the wire cuts through the lesion.   

2. 45384: The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera. He removes one or more tumors, polyps, or other lesions using hot biopsy forceps.  

3. 45381: The provider inserts a flexible endoscope into the anus and navigates the scope through the entire colon. The provider performs one or more injections into the submucosa (the tissue below the mucous membrane). 

4. 45380: The provider examines the rectum and colon using a flexible colonoscope, a tubular instrument with a light source and camera, to look for the cause of a patient’s symptoms, which may include diarrhea, constipation, rectal bleeding, or abdominal pain. He excises one or more suspicious areas of tissue using biopsy forceps and submits the specimens for laboratory analysis. 

5. 45378: The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush passed through the scope or irrigates the area with warm saline and aspirates the washings through the scope. He sends the specimens to the laboratory for diagnostic analysis. 

NOTE: It is important to note that these codes are used to diagnose colon cancer, which is different from rectal cancer. Rectal cancer has its own set of ICD-10 codes.   

Other Cancer Diagnosis Codes frequently used by Providers 

Take a look at frequently used Codes –  

1. 82270: The lab analyst uses a peroxidase activity method to perform a colorectal cancer screening test for the presence of hidden blood in a fecal specimen that the patient collects from three consecutive bowel movements to check cancer diagnosis codes. Clinicians commonly call the test a fecal occult blood test (FOBT). 

2. 82272: The lab analyst uses a peroxidase activity method to perform a test for the presence of hidden blood in a fecal specimen that the patient collects from three consecutive bowel movements, or that the clinician acquires through a method such as a digital rectal exam. Clinicians commonly call the test a fecal occult blood test (FOBT). The test is for a reason other than colorectal neoplasm screening. 

3. HSPCS Code G0121 for Colorectal Cancer Screening: colonoscopy on individual not meeting criteria for high risk. Learn here all cancer diagnosis codes.

4. HSPCS Code G0328 for Colorectal Cancer Screening: fecal occult blood test, immunoassay, 1-3 simultaneous falls under Miscellaneous Diagnostic and Therapeutic Services. 

5. 45378: The provider examines the colon and rectum using a colonoscope, a flexible tube with a camera at its inserted end. If he sees any areas of abnormal mucosa or tissue, he takes samples using a brush passed through the scope or irrigates the area with warm saline and aspirates the washings through the scope. He sends the specimens to the laboratory for diagnostic analysis. 

Other potentially useful Codes 

1. G0104: Colorectal cancer screening; flexible sigmoidoscopy 

2. G0105: Colorectal cancer screening; colonoscopy on individual at high risk 

3. G0106: Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema 

4. G0120: Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema.  

5. G0122: Colorectal cancer screening; barium enema 

Why EMPClaims is the Ideal Revenue Cycle Management Partner?  

EMPClaims is a leading provider of Revenue Cycle Management services. They specialize in helping healthcare providers maximize revenue and minimize denials. Their team of experts has extensive knowledge and experience in medical billing and coding, including the ICD-10 codes used to diagnose colon cancer.  

EMPClaims offers a wide range of Revenue Cycle Management services, including coding and documentation audits, claim submission, denial management, and revenue recovery. Their services are tailored to meet the unique needs of each client, ensuring maximum reimbursement and compliance with all regulatory requirements.  

Take Action Now  

National Colorectal Cancer Awareness Month is an important in helping to raise awareness of colorectal cancer and the importance of early screening. Healthcare providers play a critical role in this effort. Learn more at ccallaince.org.