History of polyps, screening colonoscopy

TKoehn

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As long as I can remember, I was always told that once you have polyps you can no longer have and "Screening" colonoscopy. Meaning, V76.51 cannot be a primary diagnosis. BUT recently a patient has come in arguing that his 5yr follow up colonoscopy should be coded as a screening first, then the hx of polyp code. EX: Primary DX V76.51, Secondary DX V12.72.

I did not agree with this at all but I can't find any legit documentation to support that. Something that I can give to that patient and say "Here are the rules!" (because he is not taking anyones word for it) Can anyone help me? Or does does anyone have legit documentation that proves the patient right?

He did bring in lots of stuff he found on the internet but it's all based on coders opinion. I am looking for something from CMS, AGA, etc. I cannot find anything showing that if you have a history of polyps, the V12.72 needs to be primary. Maybe I am wrong? If I am then I have been wrong for 8 years!

Any help is greatly appreciated. Thanks

Tif
 
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abb

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This is the best info I've found so far.

http:news.aapc.com/index.pp/2013/03/colonoscopy-screening-or-surveillance/


Hope this helps.
 

drakena74

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I work for an ASC. This patient is considered High risk due to personal HX of colonic polyps. These patients get colonoscopy screenings (G0105) more often than average risk screening (G0121).

Check the patient's insurance clinical/UM policies & guidelines, it will tell you how many years in between colonoscopies a patient can have for either high risk or average risk.

The way our facility would code and bill for the above patient is V12.72 as the primary dx with G0151 for procedure. It's never been an issue for us. we don't add the V76.51. because the G0151 tells them it's a screening and the V12.72 tells them why we performed the screening.

Here's an article about it. Hope it helps.

http://health-information.advanceweb.com/Features/Articles/Coding-Colonoscopies.aspx
 
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cpoeward

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See the other post titled high risk colonoscopy. If Palmetto is your carrier you may be experiencing the same problem.
 
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