Colonoscopies HELP!!!

[kbarron]

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.

 

[Anna Weaver]

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.

 

[kbarron]

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

 

[Lisa Bledsoe]

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.

 

[kbarron]

What about 45378. This pt had prev sigs and colonoscopies with known diverticular disease, as well as the above dx.

 

[coachlang3]

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.

 

[Lisa Bledsoe]

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.

 

[kbarron]

What a great forum this is. All the answers are very helpful. My coworker is now convinced.