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Screening vs. Diagnostic Colonoscopy

newport vermont
Best answers
Hi all - we are in a bit of a pickle in our practice. We had a patient who underwent what was initially a screening colonoscopy, but ultimately converted to a diagnostic colonoscopy because a polypectomy was performed during the procedure. Obviously, it didn't end up being billed as a screening colonoscopy, and the patient's insurance didn't cover it, and, much to our chagrin, ended up telling the patient that we "coded it wrong". (Ah - the bane of our existence :mad: . . . ) We discussed this with the manager of our facility's central billing department, and she seemed to think that if in the future, even when there is a polypectomy and we have to use the diagnostic procedure code, if we use the screening ICD code (i.e., V76.51, V12.72, or V16.0) FIRST, and then the pathology code second (i.e., 211.3), that the insurance companies would be more apt to cover the service because it becomes more apparent to them that this was intended to be a screening procedure that was ultimately converted to diagnostic.

First - has anyone used this method, and does it work? And secondly, is this even correct coding? Because if there's one thing that's been drilled into my head over the last 17 years that I've been coding, it's that if there are any V-codes, you ALWAYS list them last.



True Blue
Local Chapter Officer
Best answers
Screening codes would always be first..plus there are 2 mods for screening turned diagnostic pt medicare 33 commercial