Wiki Medicare Screening colonscopy turned diagnostic


Billings, MT
Best answers
I was wondering if anyone was aware if Medicare had changed it's policy on how to code screening colonoscopies turned diagnostic. Specifically I'm wondering if we still need to line link them backwards. We have to list V76.51 as the primary dx, the polyp code as secondary, and then line link them 2,1. Now that they've created the PT modifier I'm wondering if there's still a need for us to line link them that way. I put my PT modifier on but I'm hoping I can just line link them like normal with V76.51 line linked at 1 and my polyp code line linked at 2.
Any thoughts?

If the colonoscopy started off as diagnostic and polyps were found and removed, you would bill the appropriate CPT code and add -PT modifier and then bill the primary diagnosis off the pathology report and V76.51 would be additional. Hope this helps ;)
The screening diagnosis must always be first listed if it is the reason for the service provided. The coding guidelines will tell you this. Regardless of the findings or the subsequent procedure at the same session the principle #1 dx code must be the screening code.
I totally agree with you Debra. I would never put 211.3 as the primary DX and V76.51 as an additional. I think I'm going to experiment with Medicare and forget the crazy backward line linking. There shouldn't be any need for it anymore now that they have the PT modifier. I want to be able to code Medicare like I do everything else with V76.51 as primary line linked as primary. I'll keep my fingers crossed and hope they don't deny... :)
The screening dx should be listed as the #1 for the procedure and then the finding or polyp in this case as secondary and your CPT code for the removal of the polyp

for example

1. v76.51
2. 211.3

45385 (diagnosis link 211.3 for the polpy removed by this technique) -PT

The screening code is still listed as the #1 however it will not be linked (or pointed) at the CPT code. This of course is if your PM system allows you to link Dx codes for specific CPT codes.

Medicare or Commerical insurances V76.51 will always be your #1 dx for a screening colonoscopy with any additional findings listed after.
I haven't heard this has changed. I am still using the screening and then the reason and changing the pointers to reflect the opposite, 2, 1 just like you said and they are getting paid.