Wiki K63.5 vs D12.4 colon polyp

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K63.5 vs D12.4 colon polyp

Polyps are defined as an abnormal growth of tissue projecting from a mucous membrane. They are attached by a narrow stalk. Polyps often are benign, but they can become malignant over time if not removed. Coding for polyps can be accomplished by using the Index to Diseases and Injuries confirming the code choice in the Tabular List.

According to Coding Clinic, ATE (Hyperplastic versus Adenomatous Colon Polyp) (2017 Vol 4, No 1) ICD-10-CM does not classify adenomatous (neoplastic) polyps of the colon the same as hyperplastic polyps. Code K63.5 describes a hyperplastic polyp and is the default when the type of polyp is not specified as adenomatous/neoplastic. Hyperplastic polyps, by definition, are not neoplastic, and are typically followed on a much different surveillance protocol than adenomatous polyps. Category D12, Benign neoplasm of colon, rectum, anus and anal canal, classifies neoplastic polyps according to anatomic location.

You can use code D12.4 for benign neoplasm (adenomatous polyp) of descending colon.

kdavis169

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Can anyone tell me what the difference is between K63.5 and D12.4? I realize the D12.4 is a benign polyp but I am not sure the K63.5.What I am asking is Dr. performed a colonoscopy found a polyp in the descending colon retrieved polyp cold forcep...Which code would be used?
 

nsteinhauser

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Based on what it says in the ICD-10 book, I thought if the path came back as hyperplastic polyp, I would use K63.5, regardless of location in the large intestine. And if the path came back as adenomatous polyp, then I would use the D12.{0-9 depending on location in the colon}.
Does anyone have AMA/CPT/etc. documentation that addresses this issue?
Thank you in advance for your help.
 
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ICD10 Polyps - Wait for Path

With the specificity allowed in ICD10, it is best to wait for the pathology results when coding colon polyps.

The D codes will allow you to identify adenomas and specific sites and will allow for surveillance colonoscopies more frequently than an unspecified or hyperplastic polyp.

Per guidelines, hyperplastic polyps are 10 year surveillance and adenomas, based on size and or total # encountered, can be repeated sooner (2-5 years).
Not sure how sophisticated the clinical editing libraries are at the current state of ICD10, but eventually, I expect us to see denials based on frequency and previous polyps reported (K vs. D).
 

kdavis169

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I understand that we should wait for Path report , however I code for anesthesiology and that has never really been protocol in the past. So I still feel at a loss here...Thank you everyone for your replies they have been very helpful.
 

pamsbill

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I understand that we should wait for Path report , however I code for anesthesiology and that has never really been protocol in the past. So I still feel at a loss here...Thank you everyone for your replies they have been very helpful.
IMO, this is definitely going to affect all the colonoscopy billings at some point. We bill for every aspect and we usually do not wait for the pathology either. For now we have been using the K63.5, but I know at some point in the near future we are going to have to change our ways and hold everything up for the pathology reports.
 
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An additional tidbit I learned of yesterday from one of the GI physicians I work for.

He just got back from a GI seminar and stated there's discussion about left colon hyperplastic (large) polyps requiring more frequent surveillance and also due to potential error in pathology, the frequency of colonoscopy may also be changed and allowed more often when hyperplastic polyps are removed.

Not sure how we'll be able to track these since the hyperplastic polyp category in ICD10 is not site specific or size specific. Should be interesting... maybe this will be one of the first ICD10 code expansions in the upcoming year.
 

kdavis169

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Very good Information...thank you everyone for the information you all have given:)
 

Colliemom

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I agree with what was posted above, based on my research, D12 category should be used for adenomatous codes and K codes when the polyps are hyperplastic.

But now I just read something that has me concerned. Does anyone else have subscription to the "Gastroenterology Coding Alerts" by The Coding Institute? They posted an article "Keep This Colonic Polyp Code Guide at Hand to Maximize Returns." On page 82, under the heading "Hyperplastic" the article states that you should report hyperplastic polyps with D12.0 - D12.9. This is the opposite of what I have learned, and is very alarming. Has anyone else read this?
 

smcmanus

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personally coding for the hospital i'd use both the d code for location and the k635 code for the polyp..as a lesion could lead to a growth? that is just my opinionm but evidentley it did lead to a polyp..so personally i'd use both..the d for location and the k for polyp..i'm sure there will be many updates to this procedure as it is one of the most common done..lord help us thru I-10! LOL!
 
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Andrea cpc

What happens when your Dr. says he removed a polyp but the Path says Benign Lymphoid Aggregate, what code do you use then?
 
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