Wiki Screening vs Diaginostic


Kingman/Lake Havasu
Best answers
Help, from any auditors out there, Screening vs diagnostic colonoscopies, please see the questions below.

When a patient arrives with abdominal pain and the provider decides to do a colonoscopy does it have to be coded as a diagnostic service?

Does a screening colonoscopy service have to be a symptom free patient?

Is it just how the provider writes the order, screening vs diagnostic as to how to correctly code it?

call me "trying to code it right" and confused, :confused:

Kingman Az
If a patient has symptoms (ab pain, gas, BRBPR, diarrhea, constipation, etc.) requiring a colonoscopy to look for a cause for the symptom then this is not a screening.

Just because the doctor documents “screening colonoscopy" that doesn't make it a screening.

A screening colonoscopy is looking for issues absent symptoms.

A screening for medicare and most payers have a waived deductable. However, that cannot be what determines what you code. If they have a GI complaint which is the reason for the scope then it is not a screening.

I agree . . . a screening colonoscopy is just a screening, if a patient present with any diagnosis then it is considered a diagnostic colonscopy.
Does a history of polyps constitute a diagnosis? It's that age old question everyone has? What's the correct way to code a colonscopy when the patient is returning for their high-risk "screening". I know it's a fine line but we have patients calling us all the time telling us they have benefits for a preventative screening. Which I would say is a straight colonoscopy with no history. We have one patient who called us, telling us she has a high deductible and has screening benefits. However, 5 years prior had a colonoscopy where polyps where found and she was recalled to have another one done. This is the medical report, it should be noted that the doctor did an addendum adding screening as the first indication:
INDICATION: Personal history of polyps.

MEDICATION: Propofol as per Anesthesia.

PROCEDURE IN DETAIL: After informed consent was obtained from the
patient, patient was positioned on the left side. A digital rectal
exam was performed. The Olympus colonoscope was inserted in the
rectum, advanced to the cecum where the appendiceal orifice and
ileocecal valve were identified. The overall preparation was good.
There was some liquid stool. This was able to be suctioned.

FINDINGS: In the right colon, there are a few diverticula noted. At
the splenic flexure, a 2-mm polyp was seen and removed by cold biopsy.
The rectum was inspected on forward and retroflexion and there were
moderately congested internal hemorrhoids, which were not bleeding.

FINAL IMPRESSION: Right-sided diverticulosis, which was mild.
Splenic flexure polyp, 2 mm, which was removed and moderately
congested internal hemorrhoids.

RECOMMENDATION: Will be to follow up the pathology result. Most
likely, repeat the exam in 5 years.

This was coded as 45380 with v12.72 as the primary diagnosis and 211.3 as secondary. It went to their deductible. My question, I am not comfortable changing it as I don't see it as being a preventative screening, it's a high risk one. To me, that is fraud. It's quite the debate around here. Does anyone know the correct way to code it, there is such gray areas wish it could be more black and white!
This is still a screening. Please read toward the bottom of the link provided.

•Is a surveillance colonoscopy (patient has no current symptoms but a polyp or cancer was identified during a previous procedure) considered a screening?

Yes. A surveillance colonoscopy is a high-risk screening.

Unfortunately the link won't work for me. So you would code v76.51 as a primary diagnosis and v12.72 as the secondary code? Or do you use V12.72 as primary? This is such a hot debate around the office...
This is how I've always looked at it.

V76.51=screening (it is still a screening whether high risk or average)

V12.72, V10.05, V16.0, V18.51 (why they might be having a high risk screening and to establish timelines, 3-5 yrs and 10 yrs.).

If the doctor is screening the patient because of a previous finding that is no longer being treated (History of) then the patient is currently asymptomatic. But the use of the personal or family history V codes does not establish that the procedure is in fact a screening.

In the case of Medicare (and some other payors) the risk and the screening is included in the G procedure code. That's why if you use a G0105 you don't need the V76.51, you only need to put what makes it a high risk.

So if there is indeed a finding during the procedure you would need to code the reason for the procedure first (V76.51) and then the findings (211.3 or something) and then you can add any other codes such as personal or family history of. You can technically add those after the V76.51 if you so choose and I wouldn't argue against it.

If you look in the ICD-9 book the V76.51 is listed udner Special Screening for malignant neoplasms. In my Ingenix book it also shows the tip "whenever a screening exam is performed, the screening code is the first listed".

So as I said, if the patient is currently asymptomatic, regardless of past history, and the doctor wants to perform a colon for the purpose of screening for malignant neoplasm, you would use the V76.51 in the first slot.
Unfortunately the link won't work for me. So you would code v76.51 as a primary diagnosis and v12.72 as the secondary code? Or do you use V12.72 as primary? This is such a hot debate around the office...

We use the V76.51 with patients whose only indication is a personal history of colon polyps and/or family history of... Now-a-days patients have specific screening benefits. If a patient has a history of polyps or family history of colo-rectal neoplasm the patient is still currently asymptomatic so we put the V76.51 as the primary diagnosis which allows them to access their screening benefit. I asked for, and received, the blessing of our auditor with this exact issue. Of course for Medicare we do not add the V76.51 with the personal history of polyps or the family history codes because they use the "G" codes for high-risk screenings.

Additionally there is that new modifier "33" which you can use with a procedure that starts out as a screening and subsequently there is a finding which changes the procedure. We really do not use it because we use the V76.51 as the primary diagnosis for all asymptomatic patients over the age of 50 regardless of what the additional "V" codes are also used as indications.