Someone comes in for a rountine exam, has a family hx of colon polyps and nothing is found except for unspecified internal hemorrhoids and diverticulosis. Will the dx codes for the hemorroids and diverticulosis change the value of the screening? And how important is it to code those two along with the V76.51 and the V18.51?
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Wiki colonoscopies
- Thread starter Deadpd
- Start date
scorrado
Guest
Proper coding would be the reason for the procedure coded first and then any findings. Now, that said - every office and insurances have their own policies on this so you might want to check with the insurances that you encounter the most and see what they prefer.
mbort
True Blue
Are you coding for the physician or facility? If its an ASC, the rules are different according to the ICD9 book.
I dont believe that the findings would change the value of the procedure but in my experience its actually rather important to code the findings as well as the screening codes. In the scenario that you presented, the diverticulosis would mean that the patient would be, by certain insurance carrier standards, eligible to have a colonoscopy done at a more frequent interval than someone with no symptoms or history.
cconroycpch
Guest
You should code for the screening as primary and the others as secondary and additional diagnosis. For an ASC, it will not change the value.
Hi!
In my experience, I have not been able to use the screening code. I am in Michigan and I found that the carriers here do not like it. The best advice that I can give is to check your LCD for Colonoscopies/Sigmoidoscopies for Medicare especially. It should have all of the ICD-9 codes that you can use listed on there. I am not saying don't use the screening, rather just make sure it appropriate for your area. Also, beware of using hemmorhoid codes too! This Dx code is excluded from the LCD list for Michigan. We can't use it at all. Medicare won't pay and (of course) all the other payers follow. However, definitely use your diverticulosis codes, polyps, etc., if the doc documents them. I hope this helps...
Felicia Copeny, CPC-A
In my experience, I have not been able to use the screening code. I am in Michigan and I found that the carriers here do not like it. The best advice that I can give is to check your LCD for Colonoscopies/Sigmoidoscopies for Medicare especially. It should have all of the ICD-9 codes that you can use listed on there. I am not saying don't use the screening, rather just make sure it appropriate for your area. Also, beware of using hemmorhoid codes too! This Dx code is excluded from the LCD list for Michigan. We can't use it at all. Medicare won't pay and (of course) all the other payers follow. However, definitely use your diverticulosis codes, polyps, etc., if the doc documents them. I hope this helps...
Felicia Copeny, CPC-A
sundaey
Guest
was any of this discussed during the patient's first visit? If the patient has diverticulosis/diverticulitis, they usually have signs/symptoms (bouts of diarrhea, abdominal pain, etc.) if so, then it is no longer a screening colonoscopy, but a diagnostic one. As for the hemorrhoids, I have been using those codes for my scopes and they have been getting paid. However, if they just have a screening scope, and the doctor said that the pt had a normal colon, then I would use the screening code as well as the family hx code. But, from my understanding, once you have a disease present, you code the disease b/c that is what your doctor is going to be follwing up on in the office.
hope that this helps!
hope that this helps!
codegirl0422
Expert
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You may want to check with your Medicare carrier, because CMS published their guidelines in Oct or Nov 07 explaining, clarifying how it should be done. Per MC, if it started as a screening, the primary diagnosis should be screening. This is due to patients are not suppose to pay a deductible on screening colonoscopies.
Starting January 1, 2007 Medicare deductible is not waived IF the colorectal cancer screening test BECOMES a DIAGNOSTIC colorectal test, that is the service actually results in a biopsy or removal of a lesion or growth. You may find this information under the MLN Matters Number:SE0710 of the Medicare Website
Hope this helps!!!
Hope this helps!!!
High Risk
Hi. According to MCR guidelines, the patient would be considered High Risk due to family hx of colon polyps. The primary dx should be V76.51 , V18.51, and additional dx codes for the hemorroids and diverticulosis. The HCPCS code should be G0105.
See the following CPT Assistant:
JAN 2004, Volume 14, Issue 1; pgs 4-7
AHA Coding Clinic:
1Q, 1995, Volume 12, Number 1, Page 4
1Q, 2004, Volume 21, Number 1, pgs 11-12
Also search under your MCR carrier for colonscopy guidelines due to carrier discretion.
For example http://www.highmarkmedicareservices.com/policy/partb/g1/g36g.html
Thanks,
Christy
CPC, RHIT
Hi. According to MCR guidelines, the patient would be considered High Risk due to family hx of colon polyps. The primary dx should be V76.51 , V18.51, and additional dx codes for the hemorroids and diverticulosis. The HCPCS code should be G0105.
See the following CPT Assistant:
JAN 2004, Volume 14, Issue 1; pgs 4-7
AHA Coding Clinic:
1Q, 1995, Volume 12, Number 1, Page 4
1Q, 2004, Volume 21, Number 1, pgs 11-12
Also search under your MCR carrier for colonscopy guidelines due to carrier discretion.
For example http://www.highmarkmedicareservices.com/policy/partb/g1/g36g.html
Thanks,
Christy
CPC, RHIT
codegirl0422
Expert
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I apologize I had the deductible part wrong. I was trying to show that Medicare stated that the screening code should be the primary dx, even when a polyp is found, this came out in Dec 07:
" Polypectomy Performed During Screening Colonoscopy or Flexible Sigmoidoscopy,
• A patient presents for a screening colonoscopy (or flexible sigmoidoscopy), and
the patient has no gastrointestinal symptoms.
• During the subsequent screening colonoscopy (or flexible sigmoidoscopy), an
abnormality is identified (such as a polyp, etc.), and it is biopsied or removed.
CMS advises that, whether or not an abnormality is found, if a service to a Medicare
beneficiary starts out as a screening examination (colonoscopy or sigmoidoscopy), then
the primary diagnosis should be indicated on the form CMS-1500 (or its electronic
equivalent) using the ICD-9 code for the screening examination.
As an example, the above scenario should be billed as follows using claim form CMS-
1500 (or its electronic equivalent):
• Item 21 (Diagnosis or Nature of Illness or Injury)
• Indicate the Primary Diagnosis using the International Classification of Diseases,
Ninth Revision, Clinical Modification, (ICD-9-CM) code for the screening
examination (colonoscopy or sigmoidoscopy), and
• Indicate the Secondary Diagnosis using the ICD-9-CM code for the abnormal
finding (polyp, etc.).
For example, V76.51 (Special screening for malignant neoplasms, Colon) would be used
as the first listed code, while the secondary code might be 211.3 (Benign neoplasm of
other parts of digestive system, Colon).
• Item 24D (Procedures, Services, or Supplies)
• Indicate the procedure performed using the CMS Healthcare Common Procedure
Coding System/Common Procedure Terminology (HCPCS/CPT) code for the
procedure (biopsy or polypectomy), and
• Item 24E (Diagnosis Pointer)
• Enter only "2" (to link the procedure (polypectomy or biopsy) with the abnormal
finding (polyp, etc.)
A Medicare beneficiary undergoing a screening colonoscopy (no symptoms and no
abnormal findings prior to the procedure) will be responsible for the deductible if a polyp
is identified and either biopsied or removed.
When there is no need for a therapeutic procedure"
Hope this helps, sorry for any confusion
" Polypectomy Performed During Screening Colonoscopy or Flexible Sigmoidoscopy,
• A patient presents for a screening colonoscopy (or flexible sigmoidoscopy), and
the patient has no gastrointestinal symptoms.
• During the subsequent screening colonoscopy (or flexible sigmoidoscopy), an
abnormality is identified (such as a polyp, etc.), and it is biopsied or removed.
CMS advises that, whether or not an abnormality is found, if a service to a Medicare
beneficiary starts out as a screening examination (colonoscopy or sigmoidoscopy), then
the primary diagnosis should be indicated on the form CMS-1500 (or its electronic
equivalent) using the ICD-9 code for the screening examination.
As an example, the above scenario should be billed as follows using claim form CMS-
1500 (or its electronic equivalent):
• Item 21 (Diagnosis or Nature of Illness or Injury)
• Indicate the Primary Diagnosis using the International Classification of Diseases,
Ninth Revision, Clinical Modification, (ICD-9-CM) code for the screening
examination (colonoscopy or sigmoidoscopy), and
• Indicate the Secondary Diagnosis using the ICD-9-CM code for the abnormal
finding (polyp, etc.).
For example, V76.51 (Special screening for malignant neoplasms, Colon) would be used
as the first listed code, while the secondary code might be 211.3 (Benign neoplasm of
other parts of digestive system, Colon).
• Item 24D (Procedures, Services, or Supplies)
• Indicate the procedure performed using the CMS Healthcare Common Procedure
Coding System/Common Procedure Terminology (HCPCS/CPT) code for the
procedure (biopsy or polypectomy), and
• Item 24E (Diagnosis Pointer)
• Enter only "2" (to link the procedure (polypectomy or biopsy) with the abnormal
finding (polyp, etc.)
A Medicare beneficiary undergoing a screening colonoscopy (no symptoms and no
abnormal findings prior to the procedure) will be responsible for the deductible if a polyp
is identified and either biopsied or removed.
When there is no need for a therapeutic procedure"
Hope this helps, sorry for any confusion
Starting January 1, 2007 Medicare deductible is not waived IF the colorectal cancer screening test BECOMES a DIAGNOSTIC colorectal test, that is the service actually results in a biopsy or removal of a lesion or growth. You may find this information under the MLN Matters Number:SE0710 of the Medicare Website
Hope this helps!!!