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Old 02-18-2009, 09:27 AM
kbarron kbarron is offline
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Default Colonoscopies HELP!!!

Medicare Pt has pre op dx, chr Constipation, Abd pn nos, anxiety about cancer and recent change in bowel habits. What would be the correct Procedure code? Would it be considered a screening with these diags?Thanks in advance.
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Old 02-18-2009, 09:46 AM
Anna Weaver Anna Weaver is offline
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Default colonoscopy

The 787.99 change in bowel habits, allows this to be a diagnostic. Check the LCD for diagnostic and therapeutic colonoscopy/signmoidoscopy/proctosigmoidoscopy. chronic constipation is also listed, but you have to be careful with that code in particular. The unspecified abdominal pain is not listed.
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Old 02-18-2009, 10:30 AM
kbarron kbarron is offline
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We have a girl in our office that was taught to use the G codes for all colonoscopies on all Medicare pts. We are looking for additional input. Thanks
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Old 02-18-2009, 10:59 AM
Lisa Bledsoe Lisa Bledsoe is offline
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If it's a screening only then you would use the appropriate G code. BUT if a polypectomy is performed or a biopsy obtained you MUST use 45385 or 45380, etc.
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Old 02-18-2009, 11:03 AM
kbarron kbarron is offline
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What about 45378. This pt had prev sigs and colonoscopies with known diverticular disease, as well as the above dx.
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Old 02-19-2009, 07:03 AM
coachlang3 coachlang3 is offline
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If a pt presents with symptoms and that is why the procedure is taking place, that would be diagnostic not a screening, Medicare or otherwise.

You only use the G codes when there is only a screening, if something changes during the procedure ( a polyp is found) then it becomes diagnostic but you would put the V code for a screening (V76.51-colon) in the prime dx slot.

There is a spot somewhere on CMS that shows this but I can't remember. If I find it, I will post the link.

P.S. Get out of Hampton, go up to Salisbury, it's cleaner, lol.
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Old 02-19-2009, 07:54 AM
Lisa Bledsoe Lisa Bledsoe is offline
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I think if you go to the CMS website you can enter the code(s) and find the info you are looking for. Even your MAC or FI should have links.

If a patient has signs/symptoms or known disease then it is not screening and you would not be able to use the G codes.
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Old 02-19-2009, 07:58 AM
kbarron kbarron is offline
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What a great forum this is. All the answers are very helpful. My coworker is now convinced.
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Old 02-24-2009, 08:34 AM
mdunn mdunn is offline
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You may only code a G code if patient was not having any GI complaints and the procedure was only performed as a screening. If the preop dx is change in bowel habits then you would code 45378 as long as no other procedures were performed such as polypectomy, etc. For a screening colonoscopy(patient not having any symptoms) you would use G0121 or G0105, but if any polypectomies etc are performed then you would use the appropriate cpt for that procedure.
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