Medicare Screening Colonoscopies

[storves]

When the provider states that the reason for the colonoscopy is "Screening for personal history of polyps" or "Screening for personal history of Colon Cancer" or "Screening for family history of Intestional Cancer".

Should the V-code be primary or should the findings from the procedure be primary?

 

[mitchellde]

If you look at the coding guidelines they tell you that the screening V code should be listed first regardless of any findings. The findings are secondary. The findings are incidental to the the expectations in a diagnostic screening test. The expectation is that the findings will be negative because the patient has no problems or complaints. When Medicare states to drop the screening and code the diagnostic, they are referring to the HCPCs and CPT codes. The diagnosis code is the patient's.

 

[storves]

Medicare Colonoscopies

That answers part of my question.

The part I still not sure about is if the provider states Screening for history of Colonic polyps V12.72, and the patient has no other signs or symptoms. Do I put the V12.72 as primary since the provider states "screening" or do I list what is found during the procedure and then the V12.72

 

[ASC CODER]

You need a screening code then findings if any then you can use the history.
Screening v76.51
history of polyps v12.72

 

[capricew]

This really is not that difficult

if patient comes in for screening only, v76.51, v12.72 or v16.0

but the doctor finds a polyp in rectum and removes by snare, and a polyp in cecum and removes by cold forceps
the correct billing is:

45385, 45380-59 dx: v76.51(or whichever is appropriate for your pt)
569.0
211.3

please make sure when you actually bill the claim that you do not designate a diagnosis pointer to your screening dx code

45385 dx pointer will point at 569.0 only
45380-59 dx pointer will point to 211.3 only

medicare only wants the v code listed primary so that they know the intent of the procedure was for screening

now--if nothing is found

your code would be

G0105 or G0121 (depending on low or high risk category)

and dx would be v76.51 for g0121 or v16.0 for g0105

thats all there is to it


Caprice Walder, CPC