General Surgery Coding Alert

Question: Our surgeon performed a screening colonoscopy because the 37-year-old patient's uncle had been diagnosed with colorectal cancer. The surgeon removed a polyp during the procedure, and the pathology report diagnosed an adenomatous polyp. Is the correct ICD-9 code V16.0, and is this a high-risk screening (V76.51)?

Kansas Subscriber

Answer: No, you should not report V16.0 (Family history of malignant neoplasm of gastrointestinal tract) as the diagnosis in this case. Instead, you should report the pathology finding, which is 211.3 (Benign neoplasm of colon).

To use V16.0, the patient should have a family history of first degree, which means that an immediate relative such as parents, siblings, or children (an uncle doesn't qualify) had colorectal cancer.

High-risk screening: The following list shows the criteria under which a person can become eligible for a screening colonoscopy by reporting V76.51 (Special screening for malignant neoplasms colon) with the appropriate code:

• A family history (parent, sibling, or child) of colorectal cancer or adenomatous polyp (V16.0, V18.51)
• A family history of hereditary non-polyposis colorectal cancer (V16.0)
• A family history of adenomatous polyposis (V18.51)
• A prior personal history of colorectal cancer (V10.00, V10.05)
• A prior personal history of adenomatous polyps (V12.72)
• A prior personal history of inflammatory bowel disease, including ulcerative colitis and Crohn's disease. Use the ICD-9 code for the specific form of IBD.

You don't indicate any factors that justify a high-risk screening colonoscopy. Nor does the patient fit the screening criteria for most insurers, that the beneficiary be 50 years or older.

Report findings: In this case, you should report the findings from the pathology report (211.3) as the diagnosis.