Wiki Colonoscopy coding - When coding colonoscopies

[Lizzietish]

When coding colonoscopies with polypectomies, Is it necessary to hold EVERY claim for pathology? or just the ones with suspicious looking polyp removal?

I also wanted to know the difference in coding benign neoplasms vs. colon polyp? D12.4 vs. K63.5

Thanks !

 

[Whidbey]

Hello, while I can not speak to holding claims for Pathology results, I feel this would be dictated by the turn around time of results.

I can tell you the difference between D12.xx series and K63.5. The difference is that D12.xx series is for: "Included in this category are polyps specified as adenomatous or sessile serrated, dysplasia of the colon, familial polyposis, and tubulovillous adenomas. Unlike hyperplastic polyps, which have no neoplastic potential, adenomatous polyps may be precancerous." ~Encoder D12.4 "Lay Description", while K63.5 is for: " Included in this code are polyps specified as hyperplastic, which are not precancerous and are classified differently from benign or adenomatous polyps. Also reported here are colon polyps without further specificity." ~Encoder "Lay Description".

 

[dcasey4263]

Hello, I'm having an issue with insurance rejecting claims with the K63.5 and D12 codes. Is anyone else? If there are multiple biopsies taken and the ascending colon is hyperplastic polyp, the transverse is benign adenoma, do we only code the adenomas and not the polyps?

Thank you,
DCasey

 

[nsteinhauser]

Correct. You only code the adenomas and not add the K63.5. If all you have is hyperplastic, then code hyperplastic.
Hope this helps.