Colorectal CancerColorectal Cancer (CRC) is recognized as the third most commonly diagnosed malignant neoplasm worldwide and the third leading cause of cancer death in both men and women in the United States. It is estimated that there will be 135,000 new cases of CRC and nearly 50,000 deaths due to this disease in the United States in 2015.

Generally, colorectal cancer develops in the colon or the rectum. Reports suggest that the lifetime risk of developing this condition is about 1 in 20 (5%) and this is somewhat higher in men than women. The potential risk factors associated with this disease include family history or genetic factors, age, lifestyle related factors such as smoking, diet, physical inactivity, obesity or alcohol use.

Need for Early Diagnosis – Significance

CRC is a treatable disease that normally goes undetected due to lack of regular screening. In most cases, routine screening helps in finding the growth of small polyps and removing them before they become cancerous. Early diagnosis of symptoms helps in effective treatment resulting in high survival rates. Reports suggest that the survival rates of people diagnosed with primary stages of this deadly disease is 90 percent, but only 10 percent when diagnosed after it has spread to other organs.

In 2014, the American Cancer Society and the National Colorectal Cancer Roundtable (NCCRT) launched "80% by 2018" – a campaign in which they with several other organizations hoped to achieve the goal of getting 80% of Americans screened for colorectal cancer by 2018.

In most cases, people in the early stages of this debilitating disease do not experience any individual symptoms. But as the disease advances, the intensity and severity of symptoms may also change. Some of the prominent symptoms associated with this condition include cramping or stomach discomfort, abnormal bowel habits, unexpected weight loss, diarrhea, constipation, vomiting and a feeling of weakness or fatigue.

It is important for people (with no identified risk factors other than age) to undergo regular screening programs at an early age. On the other hand, people with a family history of CRC or other risk factors must discuss with physicians about the need for routine screening. Oncologists educate patients about the adverse effects of this disease and suggest prominent ways for early treatment. These physicians may recommend different standard screening tests such as colonoscopy, sigmoidoscopy, guaiac-based fecal occult blood test (gFOBT) fecal immunochemical test (FIT), CT colonography (virtual colonoscopy), and stool DNA test to identify the immediate symptoms of CRC in its primary stages.

Documenting CRC Appropriately

Cancer physicians while administering different treatment modalities have to report accurate diagnostic and procedural codes on the claims to ensure due coverage. The following ICD codes are used for medical billing purposes –

ICD-9 codes

  • V10.0 – Personal history of malignant neoplasm of large intestine (high risk screening code)
  • V10.06 – Personal history of malignant neoplasm of rectum, rectosigmoid junction, and anus (high risk screening code)
  • V12.72 – Personal history of adenomatous colonic polyps (high risk screening code)
  • V16.0 – Family history of malignant neoplasm of gastrointestinal tract (first degree relative-sibling, parent, child) (high risk screening code)
  • V18.51 – Family history, adenomatous colonic polyps (high risk screening code)
  • V76.41 – Special screening for malignant neoplasms of rectum
  • V76.51 – Special screening for malignant neoplasms of colon
  • V84.09 – Genetic susceptibility to other malignant neoplasm (not covered by all payers)

ICD-10 codes

Here are some of the ICD-10 Codes that support payment of the corresponding CPT/HCPCS procedures as a preventive benefit (not subject to deductible) for dates of service on or after October 1, 2015:

  • Z12.11 Encounter for screening for malignant neoplasm of colon
  • Z12.12 Encounter for screening for malignant neoplasm of rectum
  • Z80.0 Family history of malignant neoplasm of digestive organs
  • Z83.71 Family history of colonic polyps
  • Z85.00 Personal history of malignant neoplasm of unspecified digestive organ
  • Z85.01 Personal history of malignant neoplasm of esophagus
  • Z85.030 Personal history of malignant carcinoid tumor of large intestine
  • Z85.040 Personal history of malignant carcinoid tumor of rectum
  • Z86.010 Personal history of colonic polyps

The CPT/HCPCS procedure codes include codes from 45330 to 45334, and 45338 and 45346 for sigmoidoscopy. Colonoscopy codes are the following.

  • 45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
  • 45380 Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple
  • 45382 Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding (e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator)
  • 45384 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
  • 45385 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
  • 45388 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) (Not covered for Medicaid)

For Medicare Part B claims, physicians must report colorectal cancer screening tests with the appropriate HCPCS Level II or CPT® code:

G0104 Colorectal cancer screening; flexible sigmoidoscopy
G0105 Colorectal cancer screening; colonoscopy on individual at high risk
G0106 Colorectal cancer screening; barium enema; as an alternative to G0104, screening sigmoidoscopy
82270 Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided 3 cards or single triple card for consecutive collection)
G0120 Colorectal cancer screening; barium enema; as an alternative to G0105, screening colonoscopy
G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
G0122 Colorectal cancer screening; barium enema
G0328 Colorectal cancer screening; immunoassay, fecal-occult blood test, 1-3 simultaneous determinations
Important: Code GO122 is a non-covered service.

100% of the Medicare-approved amount is paid for flexible sigmoidoscopies, FOBTs, colonoscopies, and multi-target stool DNA tests, and 80 percent for barium enemas. A Part B deductible does not apply in any case though coinsurance applies to colonoscopies and sigmoidoscopies performed in ambulatory surgical centers and non-Outpatient Prospective Payment System hospitals. Age and frequency are among the conditions of coverage for colorectal screening tests. Beneficiary co-insurance and deductible have been waived for anesthesia service – 00810 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum – when performed with a screening colonoscopy.

Smoking Increases Risk of Early Death in CRC Survivors – Finds Study

A new study found that the habit of smoking may increase the risk of earlier death for people who have survived colorectal cancer (CRC). The study conducted by researchers at the American Cancer Society (one of the largest studies of smoking and CRC survival and the first study to prospectively collect both pre- and post-diagnosis smoking information) was published online February 2 in the Journal of Clinical Oncology. It was found that colon cancer survivors who smoke cigarettes face more than twice the risk of death compared to non-smoking survivors.

Presently, there is clear evidence that smokers have increased chances of being diagnosed with CRC. However, there is no clear evidence suggesting an association with survival after colon cancer diagnosis.

In order to examine the direct association of smoking (before and after diagnosis) with all-cause and colorectal cancer-specific mortality among survivors, researchers studied 2,548 people newly diagnosed with invasive, non-metastatic colon cancer from a total of 184,000 adults in the American Cancer Society’s Cancer Prevention Study II. The key finds include –

  • Out of 2, 548 CRC survivors, 1,074 suffered death during an average of 7.5 years of follow-up time, including 453 as a result of colorectal cancer.
  • People who were active smokers before diagnosis had more than twice the risk of death from all causes as well as from risk of dying of CRC.
  • It was found that former smoking prior to diagnosis was associated with higher all-cause mortality, but not with CRC specific mortality.
  • Cigarette smoking after diagnosis has direct link with more than double the risk of overall mortality (throughout the study). In addition, it was associated with nearly twice the risk of CRC – specific mortality.

Researchers conclude that it is possible that smokers may have more aggressive tumors or that this habit may eventually decrease the total efficacy of cancer treatment. They conclude that further research is essential to understand the correct mechanisms whereby smoking may increase CRC specific mortality and identify whether quitting smoking after diagnosis lowers the same death risk.