Wiki Colonoscopy Coding Issues

[tian17]

I have a question about CPT/DX coding for Colonoscopies - we are having trouble when we are performing a screening colonoscopy and removing polyps then bringing the patient back in 6mths for the repeat colonoscopy. The repeat is being denied due to a second screening too soon. Anyone have suggestions on how to code these? Or get these reimbursed? Guidelines suggest that when the patient has a large polyp or a high-grade neoplasia to bring them back to make sure all was removed, but then it is denied and patients do not want to come back. Looking for guidance. Our coders are billing both as screenings with the findings secondary....(I cannot find anything as a coder myself to disagree with them) but it is not working.

 

[TThivierge]

Coding Colonoscopies

Hi

You need a modifier on the CPT when the same doc is doing this colon procedure again in less than a year.Try modifier 76 with gastro CPT and send medical record with claim showing why had to redo it. Please have doc list this in his notations too. Use the proper dx. sequencing , the proper Z dx. codes should come last not first. A definitive dx should come first especially if polyp regrew again. Ensure the gastro CPT codes are not unbundling the CPT manual will tell you that under each CPT code description in which certain CPT codes cannot be billed together. Also check out the Medicare CCI edits for guidance. Also differ areas of colon and differ clinical procedures(hot bx vs cold bx) can be billed in which ways to have removed polyp.

Anyway good luck !

Lady T

 

[thomas7331]

I have a question about CPT/DX coding for Colonoscopies - we are having trouble when we are performing a screening colonoscopy and removing polyps then bringing the patient back in 6mths for the repeat colonoscopy. The repeat is being denied due to a second screening too soon. Anyone have suggestions on how to code these? Or get these reimbursed? Guidelines suggest that when the patient has a large polyp or a high-grade neoplasia to bring them back to make sure all was removed, but then it is denied and patients do not want to come back. Looking for guidance. Our coders are billing both as screenings with the findings secondary....(I cannot find anything as a coder myself to disagree with them) but it is not working.

As per your description above, that the purpose of the procedure is "to bring them back to make sure all was removed", then by definition this is not a screening service and should not be coded as a screening. Screenings are only for asymptomatic patients without a known problem requiring treatment or monitoring, and the benefit for a screening is limited by most payers to once per 5 or 10 years depending on the patient's level of risk. These should be coded as diagnostic procedures and coded as follow-up care for the polyps, and then they will be paid under the patient's medical benefit rather than the preventive services benefit. If they're being coded as screenings, then of course they will deny as that preventive benefit has already been used within the allowed time period.