Wiki Colonoscopy for screening or surveillance

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Lisa Bledsoe

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Personally, this article muddied the waters even more for me. I was taught that once there was a history of (polyps or cancer) to use that particular V code rather than V76.51 as primary; that it was no longer a screening issue, rather a medical issue based on history. I am as confused as ever now.
 
mdunn said:
Well, I was taught that it was still a screening even if there was a history of cancer or polyps, but the diagnosis would become 211.3, etc depending on the findings and procedure peformed. For instance, if a patient came in for history of colon polyps and a polyp is found and removed with snare you would code: V76.51
211.3

Proc: 45385

If they came in for history of polyps and nothing was found you would code:
V76.51 and V12.72.

I'm glad that I'm not the only one confused by this. I hope someone can clarify this with facts and not opinions.
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This is the way the dx coding guidelines state to do this and this is what is supported by the documentation of the PATIENT'S condition and reason for the procedure. I really think that when the payers issue directives that state things like when it was started as screening and a diagnostic procedure is performed as result of findings to code the diagnostic.... or to that effect they are referring to procedure codes. A payer cannot dictate to the provider what the dx is, that is determined by the provider, the payer can determine whether a screening procedure code is correct or it should be diagnostic, With a colonoscopy, the rules being the way they are we cannot use a screening procedure code with the diagnostic procedure code so we must drop the screening PROCEDURE code, however the dx remains as dictated by the physician.
 
Followup or surveillance I would use a V67.xx code but a screening would be V76.51 first listed, any other hx of codes would be secondary. Any findings would be secondary. If you go to the coding clinics I am sure there are several on this issue, that is if you have access to coding clinics, Hospitals usually have these in the HIM department. Most code books will show an AHA reference listed under the code that will tell you which one(s) to look at. Also the coding guidelines from the CDC website.
 
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