Colonoscopy Coding for Outpatients


In this course, participants will gain a comprehensive understanding of medical coding for colonoscopies in outpatient settings. This program equips coders with the knowledge and skills to accurately assign diagnosis and procedure codes, ensuring compliance with evolving guidelines and regulations. Through in-depth lessons, participants will explore various scenarios and challenges encountered in coding colonoscopies, such as screening, diagnostic, and follow-up procedures. The course covers essential topics, including proper diagnosis coding, modifier usage, and the nuanced differences between screening and diagnostic colonoscopies. Participants will also learn how to code for polyp and lesion removals, staying up-to-date with the latest coding guidelines.

Included Lessons:

  • What is a Colonoscopy?
  • Photo of Large Intestine
  • Problems with Coding Coloscopies
  • Diagnosis Coding for Outpatient Colonoscopy
  • Diagnostic Colonoscopy CPT/HCPCS
  • Screening Colonoscopy CPT/HCPS
  • Follow Up Colonoscopy CPT/HCPS
  • Modifier Use in HOPPS for Incomplete Colonoscopy (Pro-fee Discussed After)
  • Screening Colonoscopy Which Becomes Diagnostic
  • Follow Up Screening Colonoscopy After Positive Non-Invasive Stool Based Colorectal Cancer Screening Test
  • Ensure the Correct CPT Code For Polyp or Lesion Removals
  • NCCI Manual Regarding Endoscopy
  • Additional Documents
CEUs available for the following credentials:




Key Takeaways

  • Understanding of Colonoscopy Procedures: Participants will gain a thorough understanding of what a colonoscopy is, its purpose, and its significance in preventing and detecting colorectal cancer.
  • Diagnosis Coding: Coders will learn how to appropriately assign diagnosis codes based on the nature of the colonoscopy, whether it is for screening, diagnosis, or treatment. This includes distinguishing between various clinical scenarios and conditions.
  • CPT/HCPCS Procedure Codes: Participants will become proficient in selecting the correct Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes for different types of colonoscopies, including screening, diagnostic, and therapeutic procedures.
  • Modifier Usage: The course covers the proper use of modifiers, such as -73 and -74, for incomplete colonoscopies and other scenarios where modifiers are necessary for accurate coding.
  • High-Risk and Follow-Up Colonoscopies: Coders will learn how to code high-risk and follow-up colonoscopies accurately, considering factors like personal history of polyps and specific patient conditions.
  • Compliance with Changing Guidelines: Given the evolving nature of healthcare regulations and guidelines, participants will be updated on the latest changes, such as those related to Medicare coverage policies and waiver of Part B deductibles.
  • Polyp and Lesion Removal Coding: Coders will be equipped with the skills to select the appropriate CPT codes for the removal of polyps and lesions during colonoscopy procedures, taking into account the method used for removal.
  • NCCI Guidelines: Participants will become familiar with National Correct Coding Initiative (NCCI) guidelines related to endoscopic services and understand how they apply to colonoscopy coding.
  • Documentation Interpretation: The course will enhance participants' ability to interpret physician documentation accurately to ensure correct code assignment.
  • Adherence to MAC and Payer Instructions: Coders will learn the importance of staying informed about and complying with Medicare Administrative Contractor (MAC) and payer instructions, as these can vary and impact coding decisions.

Benefits of Taking this Course

  • Enhanced Coding Accuracy
  • Improved Ability to Assign Correct Codes for Colonoscopies
  • Career Advancement
  • Increased Confidence
  • Continuing Education


What is the difference between a screening and diagnostic colonoscopy, and how do I code them?
A screening colonoscopy is performed on a patient without any signs or symptoms, primarily for preventive purposes. It is coded using CPT codes G0105 for high-risk patients and G0121 for non-high-risk patients, or the appropriate screening code if these are not accepted. A diagnostic colonoscopy is conducted when a patient has specific symptoms or a known medical condition. It should be coded based on the primary reason for the procedure, with the associated diagnosis code.
How do I code follow-up colonoscopies, and when are they necessary?

Follow-up colonoscopies are typically performed after a patient has had a previous colonoscopy with polypectomy or other colon surgery. The coding should reflect the reason for the follow-up, such as monitoring for polyp recurrence or healing progress. Use the appropriate diagnosis and procedure codes to accurately convey the nature of the follow-up.

About our Medical Coding Courses

HIAlearn, powered by Health Information Associates (HIA)—a leader in medical coding and auditing for more than three decades—offers a comprehensive online education platform for medical coders. With a catalog of over 200 medical coding courses accepted by the American Health Information Management Association (AHIMA) for Continuing Education Units (CEUs) and a selection approved by the American Academy of Professional Coders (AAPC), HIAlearn caters to both beginners and experienced medical coders seeking to enhance their skills. The platform provides an array of training plans tailored to meet individual learning needs, from mastering challenging coding procedures to understanding broad conceptual frameworks within the coding world. Courses are available across various coding types including CPTE/M, ICD-10-CMICD-10-PCS, and are designed to cater to different coder levels and coding specialties such as inpatientoutpatientprofee, and CDI. Additionally, HIAlearn offers a Coding Updates bundle to ensure coders are up-to-date with the annual changes in ICD-10-CMICD-10-PCSCPT, and IPPS. Beyond individual learning, HIAlearn supports organizations with group discounts, promoting enhanced coding accuracy, efficiency, and compliance across teams. 

Disclaimer: This course is not for individual sale. Purchase the CPT Coding Training Plan below and get access to 46 total CEUs. 

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