Correct hospital coding colonoscopy

slpagel

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Athens, GA
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:eek: HI, I NEED SOME INPUT FROM A HOSPITAL CODER. ALL MY CMS REGS TELL ME WHEN DOING A SCREENING CSCOPE FOR V12.76 I SHOULD USE G0105.

I HAVE OUR REGIONAL HOSPITAL BILLING 45378 WITH V12.76. THEY SAY THAT SINCE HE HAS HAD POLYPS IN THE PAST IT'S NO LONGER SCREENING. THE CODING MANAGER STATES THAT THEY FOLLOW "CODING CLINIC" REGS. NOW THIS WILL CAUSE THE PATIENT PAY OUT OF POCKET.

PLEASE HELP ME GET TO THE BOTTOM OF THIS ISSUE.
 

mitchellde

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Coding Clinics are from the AHA and cover ICD-9 CM coding only so they did not get the information regarding the CPT code from the coding clinics. I agree that the hx of polyps makes the patient more high risk and I would use the code for hx of polyps in addition to the screening V code but the screening G code for the procedure if this is a Medicare patient is correct as this is still screening, the patient is just more high risk.
 
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