Part B Insider (Multispecialty) Coding Alert

Published on Fri Jan 27, 2012 PDF

Question: We have a 39-year-old patient who is asking for a routine screening of the colon, as some of his cousins and his uncle have been diagnosed with colorectal cancer. Can this be billed under V16.0? Also, can you let me know the criteria for high risk screening under V76.51?

Answer: For the screening to be billed under V16.0 (Family history of malignant neoplasm of gastrointestinal tract), the person should have a family history of first degree which means that an immediate relative such as his parents, his siblings or his children. In this situation, your patient's service should not be billed using V16.0 as the relatives (uncle, cousins, etc.) are not classified as first degree family members.

The following are the criteria under which a person can become eligible under high risk category for colonoscopy screening using a code separate from V76.51 (Special screening for malignant neoplasms colon), based on information from the CMS Web site (www.medicare.gov/navigation/manage-your-health/preventive-services/colon-cancer-screening.aspx?AspxAutoDetectCookieSupport=1):

• A family history (parent, sibling or children) 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.