Wiki Colonoscopy Screening - Medicare

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Rybicki1

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How would you code a colonoscopy screening for Medicare? Patient has personal hx of polyps and is coming in for surveillance.

A coworker is telling me she codes as below. Do you agree?

45380 - PT
Z12.11
Z86.010
K63.5
K57.30

PREOPERATIVE DIAGNOSIS: 1.History of colon polyps. 2.Constipation.
POSTOPERATIVE DIAGNOSIS: 1.Colon polyps x1 .2.Mild sigmoid diverticulosis.

PROCEDURE PERFORMED: Colonoscopy with biopsy.
ANESTHESIA: Monitored anesthesia care.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPECIMEN: Polyp at 20 cm.

INDICATIONS FOR PROCEDURE: 68-year-old gentleman with previous history of polyps as well as worsening constipation who comes for evaluation of this condition.

DESCRIPTION OF PROCEDURE: After obtaining written consent and explaining all the risks, benefits, and alternatives associated with this procedure, the patient was taken to endoscopy suite and placed in the left lateral decubitus position. Monitored anesthesia care was started. When appropriate levels were achieved, a digital rectal examination was performed. There were no palpable masses or perianal disease identified. A well-lubricated endoscope was introduced and navigated all the way to the cecum that was verified by the presence of the ileocecal valve and appendiceal orifice. Careful examination of the ascending, transverse, and descending colon was performed in a retrograde and circumferential manner. There was no evidence of any masses or strictures, but there was a single small polyp in the sigmoid colon that was removed with cold biopsy polypectomy as well as mild sigmoid diverticulosis. Other than this, there were no other abnormalities. A retroflexion maneuver at the level of the rectal vault showed there were no abnormalities in the inside aspect of anal canal. The endoscope was then fully retrieved and the patient was transferred.

***PATH CAME BACK AS HYPERPLASTIC POLYP***

Thank you! :)
 
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Hi Thank you for the reply. I agree but if it was just for the surveillance and the constipation wasnt listed how would you code this?
 
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Rybicki1 said:
How would you code a colonoscopy screening for Medicare? Patient has personal hx of polyps and is coming in for surveillance.

A coworker is telling me she codes as below. Do you agree?

45380 - PT
Z12.11
Z86.010
K63.5
K57.30

PREOPERATIVE DIAGNOSIS: 1.History of colon polyps. 2.Constipation.
POSTOPERATIVE DIAGNOSIS: 1.Colon polyps x1 .2.Mild sigmoid diverticulosis.

PROCEDURE PERFORMED: Colonoscopy with biopsy.
ANESTHESIA: Monitored anesthesia care.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
SPECIMEN: Polyp at 20 cm.

INDICATIONS FOR PROCEDURE: 68-year-old gentleman with previous history of polyps as well as worsening constipation who comes for evaluation of this condition.

DESCRIPTION OF PROCEDURE: After obtaining written consent and explaining all the risks, benefits, and alternatives associated with this procedure, the patient was taken to endoscopy suite and placed in the left lateral decubitus position. Monitored anesthesia care was started. When appropriate levels were achieved, a digital rectal examination was performed. There were no palpable masses or perianal disease identified. A well-lubricated endoscope was introduced and navigated all the way to the cecum that was verified by the presence of the ileocecal valve and appendiceal orifice. Careful examination of the ascending, transverse, and descending colon was performed in a retrograde and circumferential manner. There was no evidence of any masses or strictures, but there was a single small polyp in the sigmoid colon that was removed with cold biopsy polypectomy as well as mild sigmoid diverticulosis. Other than this, there were no other abnormalities. A retroflexion maneuver at the level of the rectal vault showed there were no abnormalities in the inside aspect of anal canal. The endoscope was then fully retrieved and the patient was transferred.

***PATH CAME BACK AS HYPERPLASTIC POLYP***

Thank you! :)
Click to expand...
Since the patient is considered high surveillance, I would use
G0105, since patient has personal history of colon polyps that is considered high risk surveillance screening
 
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mfm1988 said:
Since the patient is considered high surveillance, I would use
G0105, since patient has personal history of colon polyps that is considered high risk surveillance screeHello, C
Click to expand...

mfm1988 said:
Since the patient is considered high surveillance, I would use
G0105, since patient has personal history of colon polyps that is considered high risk surveillance screening
Click to expand...
Hello, can you code G0105 with findings? In this example K63.5
 
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Hi, I would code this as 45380-PT K63.5 since a polyp was removed. The PT modifier lets Medicare know this started as a screening. For Commercial insurances, use the Z12.11 along with the 33 modifier when the reason is screening. Hope this helps.
 
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