Juvenile Polyposis Syndrome

mconner001

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I have a provider who did an EGD and Colonoscopy on at 26 year old with commercial insurance. No findings. Her indications state the JPS with a dx code of K63.5. That would do for the colonoscopy (or is the D12.6 supposed to be used like with the case of Familial Polyposis?) but what about the EGD? Do I use a K31.89 in this instance? I looked in the ICD 10 code book under Polyposis, Polyps, Syndromes and am not sure what to use. Any help would be appreciated.
 

kpeterson15

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For the EGD, if no findings were found, couldn't you use the reason why she was getting the EGD done in the first place?
 

mconner001

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That's the bottom line - yes, normally I would. However, her indication for the EGD is the K63.5, colon polyp. I don't think the insurance will accept that. However, I'm unable to find a dx code for the Juvenile Polyposis Syndrome.
 

kpeterson15

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Interesting.. I am no doctor but that’s a very weird indication for an upper endoscopy. Lol. That does not sound that insurance would cover it at all. She didn’t have any stomach pain or anything listed in the encounter that called for the endoscopy?? Or nausea???
Let me see if I can help with the diagnosis Juvenile Polyposis Syndrome.
 

kpeterson15

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That's the bottom line - yes, normally I would. However, her indication for the EGD is the K63.5, colon polyp. I don't think the insurance will accept that. However, I'm unable to find a dx code for the Juvenile Polyposis Syndrome.
Could you use a personal history or family history code for the diagnosis? Or a screening code with the personal history or family history with it to support it?
 

mconner001

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I verified with our consulting firm: There is no 'screening' for an EGD. They advised using the D12.6 for both procedures and having the patient sign a waiver for the EGD since it probably won't be considered medically necessary. Use of a K code would not be appropriate since the patient is asymptomatic.
 
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