Dx for colonoscopies

bethh05

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I have been coding colonoscopies for an ASC for a while. All the reading I have done states to use the V76.51 first, if the patient comes in for a screening, even if it turns into a biopsy. Some insurances are denying the 45380, 45384 or 45385 with the V code even with 211.3 secondary. Any suggestions would be greatly appreciated!
 

debaloia

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When a pt schedules for a screening colonoscopy and the doctor finds polyps the colonoscopy is no longer considered a screening. I would use the code for the appropriate colonoscopy type ie: 45384 and 211.3 as primary. The finding on exam should be primary then the reason of the visit, so the v code would be secondary. Hope this helps.

Debbie
 

amy_mousie

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correct

that is also my understanding - I believe you can have the screening code as a second dx but since the polyps were found it would be the prim dx and therefore no longer considered a screening so you would be coding the diagnosis and not screening.
 

code3jill

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If anything other than a screening is done, you must code the dx from lab, bx or polypectomy result. Screening is only for no findings.
 

coachlang3

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RE: DX for colon

I've had a different experience.

We put the screening dx first to show it was meant for a screening and then on the second line we put the proc and the polyp dx to show the conversion. This shows up correctly on a HCFA but on a UB the actual proc shows on the line and the V code shows as first dx and the 211.3 shows as secondary. We 've encountered the occasional issue but not on a consistent basis and rarely from the same insurance.

The screening is still a screening converted to a diagnostic though since the pt did not present with symptoms but polyps were found.

Just what I've seen from our practice in NC though.

edit: I'm basing this on CMS standards set forth from the MLN Matters # SE0746. In the article it states:

"CMS advises that, whether or not an abnormality is found, if a service to a Medicare beneficiary starts out as a screening exam (colon or sigmoid), then the primary dx should be indicated on the form CMS-1500 (or its electronic equivalent) using the ICD-9 code for the screening examination.
 
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elenax

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I agree with coachlang3: for Medicare you code first the screening diagnosis and the findings second: please read the following:

(This is the way it was before) when the surgeon visualizes and biopsies the polyp, you should change the primary diagnosis from V76.51 (Special screening for malignant neoplasms; colon) to, for instance, 211.3 (Benign neoplasm of other parts of digestive system; colon), as outlined in the instructions CMS provided in February.

The retraction: Now, CMS officials are distancing themselves from their earlier instruction, pointing to language in the ICD-9 diagnosis coding guidelines that state that you should still use the screening diagnosis even if you find a problem during a screening exam.

"Should a condition be discovered during the screening, then the code for the condition may be assigned as an additional diagnosis," according to ICD-9 instructions.

Possible solution: Some experts have recommended listing the V code as the primary diagnosis in Box 21 of the claim form, but then including a "2" next to the procedure code in Box 24. This will let the carriers know that the secondary diagnosis, the polyp code, is the one that they should associate with the procedure code. Cobuzzi warns, however, that this won't work with most billing software.

hope this helps!!!
 
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