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polyp removal during screening

codegirl0422

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310
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Please help,
How do you get dx V76.51 as the primary dx when you do not key it with a procedure code. Based on Medicare's guidelines, you are to only use 2 in the dx pointer next to the polyp removal. Any help with posting the charge would be greatly appreciated. My software does not let me put in a dx without keying a procedure first and I have sent the explanation to the software's help desk and they can't seem to figure it out. Right now, I key the charge with V76.51 first and 211.3 2nd and it pays ok, but it is not billed according to Medicare guidelines.

Thanks a bunch for any help

“CMS advises that, whether or not an abnormality is found, if a service to a Medicare beneficiary starts out as a screening examination (colonoscopy or sigmoidoscopy), then the primary diagnosis should be indicated on the form CMS-1500 (or its electronic equivalent) using the ICD-9 code for the screening examination.

Item 21 (Diagnosis or Nature of Illness or Injury)
Indicate the Primary Diagnosis using the International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) code for the screening examination (colonoscopy or sigmoidoscopy), and
Indicate the Secondary Diagnosis using the ICD-9-CM code for the abnormal finding (polyp, etc.).

Item 24E (Diagnosis Pointer)
Enter only "2" (to link the procedure (polypectomy or biopsy) with the abnormal finding (polyp, etc.)”
 

elenax

Expert
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328
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Stuart
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I am having the same problem and I get paid anyway...but as codegirl some feedback will be appreciated!
 

Lisa Bledsoe

True Blue
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2,045
Location
Greeley, Colorado
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We have the same issue...have asked our vendor for a fix. They "think" they have it fixed, but since the "fix" won't drop to paper, it will only go electronically, I am not able to see it. We are in the "test" phase of the "fix". Honestly, I am not optimistic that the vendor has fixed the issue and that they understand the importance of it.:mad:
 

scorrado

Expert
Messages
293
Location
Virginia
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Our software company was able to make a format change so that when I am submitting a claim to Medicare and the procedure code is 45380 to 45385 it will automatically point the diagnosis to the second diagnosis if I have 2. All other companies I use the V7651 as the second until they say different. I would definitely be talking to your software company about your problem because eventually all other insurance are probably going to go to this so if they aren't understanding or able to fix something this minor now you might want to think about switching. After I explained what I needed it took only about 15 minutes for the girl to fix the issue.
 

milema2

Contributor
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12
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I am in the same boat, The "fix" is going electronic but not on paper. You are right about other Insurances companies following suit. We have a local insurance company here in VA, We are coding the V76.51 first regardless of what we find. Per guidline from the insurance company.
Margie Miles, CPC
 

codegirl0422

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310
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So does charge entry key V76.51 first and then 211.3. And then your software company's format change changes it. Does it still leave V76.51 in the 1st dx spot. (I'm having a hard time explaining to my software vendor that V76.51 needs to be in 1st dx spot and not linked to a procedure) ~~ only asking advice for Medicare patients, hopefully others will not follow suit, at least till I can get this worked out.

Our software company was able to make a format change so that when I am submitting a claim to Medicare and the procedure code is 45380 to 45385 it will automatically point the diagnosis to the second diagnosis if I have 2. All other companies I use the V7651 as the second until they say different. I would definitely be talking to your software company about your problem because eventually all other insurance are probably going to go to this so if they aren't understanding or able to fix something this minor now you might want to think about switching. After I explained what I needed it took only about 15 minutes for the girl to fix the issue.
 

scorrado

Expert
Messages
293
Location
Virginia
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0
Both dx show up on the claim but the procedure code only links to the second diagnosis. If you had an actual claim form in front of you Box 21 would have V7651 as the first diagnosis and and 2113 would be your second. Then when you get to box 24E where you put the diagnosis that corresponds to the procedure you are billing for you would tell your software company to only put a 2 there when you are billing for Medicare and you are billing procedure codes 45380-45385 and there are 2 diagnosises. This is how I explained it to them and they were able to get it working correctly. I do not have the issue with paper claim like others are having because we cannot send paper claims to Medicare so I did not even check that when it was set up for us.
 

codegirl0422

Expert
Messages
310
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thanks, I will try to explain it this way, hopefully this will work, I don't have the situation with paper either, all of mine have to go electrically. I just want to get this issue fixed before I have other carriers following suit. Currently MC pays with the primary dx as V76.51 but I am scared their edits may change since V76.51is not a payable on the LCD. I appreciate your help.

Both dx show up on the claim but the procedure code only links to the second diagnosis. If you had an actual claim form in front of you Box 21 would have V7651 as the first diagnosis and and 2113 would be your second. Then when you get to box 24E where you put the diagnosis that corresponds to the procedure you are billing for you would tell your software company to only put a 2 there when you are billing for Medicare and you are billing procedure codes 45380-45385 and there are 2 diagnosises. This is how I explained it to them and they were able to get it working correctly. I do not have the issue with paper claim like others are having because we cannot send paper claims to Medicare so I did not even check that when it was set up for us.
 
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