Wiki Case #11 Winner, Answer Key, & Rationale

[alex.mckinley@aapc.com]

Melinda P. is the winner of case #11. See below for the answer key and rationale.

ANSWER KEY
CPT: 45380
CPT Modifiers: 33
ICD-9: V76.51, 211.3, 562.10, 455.0

RATIONALE
This non-Medicare patient is scheduled for a screening colonoscopy. During the procedure a polyp is removed. Polyp removal with cold forceps is reported as a biopsy.

CPT: 45380-33

Steps to look up: Colonoscopy/Flexible/Biopsy. Modifier 33 appended to indicate a screening colonoscopy was planned. AMA created modifier 33 to allow providers to identify to insurance payers and providers that the service was preventive under applicable laws with no patient cost-sharing (PPACA). An example of this can be a screening colonoscopy (45378) resulting in a polypectomy (45383).

http://news.aapc.com/index.php/2011/03/new-modifier-33-in-oce-update/
http://www.aapcps.com/news-articles/Modifier-33-not-for-Medicare.aspx

ICD-9-CM: V76.51, 211.3, 455.0

Steps to look up: Screening/colonoscopy; Polyp, polypus/colon; Hemorrhoids/internal

 

[cmontyrn]

Case # 11 clinical added for Answer key & Rationale

Case # 11 clinical added for Answer key & Rationale
Since the clinical info wasn't included in posting of answer & rationale; and the link to case clinical info given now is not accessible (error page shows up) .... I thought it wise to include the missing clinical info.


Hint: Case 11 involves a 46-year-old male patient presents for an elective (screening?) outpatient colonoscopy. You?ll need your knowledge of modifiers and CCI edits for this scenario.


Case# 11

Introduction: A 46-year-old male patient presents for an elective outpatient colonoscopy.

Indications: Screening.

Consent: The benefits, risks, and alternatives to the procedure were discussed and informed consent was obtained from the patient.

Preparation: Pulse, pulse oximetry and blood pressure were monitored throughout the procedure.

Medications:
* Versed 5 mg IV throughout the procedure.
* Fentanyl 100 meg IV throughout the procedure.

Rectal Exam: Normal rectal exam.

Procedure: The colonoscope was passed with ease through the anus under direct visualization; it was extended to the cecum, confirmed by appendiceal orifice and ileocecal valve. The scope was withdrawn and the mucosa was carefully examined. The quality of the preparation was good. The views were good. The patient?s toleration of the procedure was good. Retroflexion was performed in the rectum.

Findings: Cecum, ascending and transverse colon - unremarkable. At 50 cm - diminutive polyp removed by cold forceps. Descending and sigmoid - diverticuli. At 20 cm, diminutive polyp removed by cold forceps. Rectum - internal hemorrhoids.

Complications: There were no complications associated with the procedure.

Impressions:
* Cecum, ascending and transverse colon - unremarkable.
* At 50 cm - diminutive polyp removed by cold forceps.
* Descending and sigmoid - diverticuli.
* At 20 cm, diminutive polyp removed by cold forceps.
* Rectum - internal hemorrhoids.

Recommendations:
* Follow-up on the results of the biopsy specimens.
* Repeat colonoscopy in 5 years depending upon results of pathology.

Biopsy results: Benign polyp

Non-Medicare patient

https://www.aapc.com/code/aapc-coding-challenge/cases.aspx