Screening vs procedure

kathymoon

kathymoon

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We are billing BCBS of Michigan and the patient is scheduled for a screening colonoscopy. We end up doing several polyp removals. Do we bill the procedures with screening and second diagnoses of polys or do we bill with just the polyp removal? Thanks.
 
I just had this situation also arise and according to my compliance department as long as the screening diagnosis is supported in the documations we bill the screening as prim dx and the polyp dx as 2nd.. hope this helps! We are seeing several other insurance's going this way.
 
We are also billing the screening code primary as long as it is stated in the operative report and using the polyp as secondary.
 
I code for these everyday, and when their scheduled for the screening, but while during the procedure they found something we code the findings as primary and the v-code as secondary.
 
This answer can be found in your ICD-9 book. It reads: A screening code may be listed as primary if the reason for the visit is specifically the screening exam. If a condition is discovered during the screen, then the condition should be assigned as an additional dx.

If the polyps were truly an incidental finding, then you should code the colonoscopy w/ polyp removal w/ screening primary and polyps secondary.
 
The method that Medicare and other payors want to see for this type of scenario codes is to list the V76.51 as the primary DX code,then list for the polyp as #2. However when entering the charges you will want to sequence the Dx codes as 2,1 to the procedure, an example would be;
#1 V76.51 #2 211.3
CPT 45385 2,1 on the HCFA
This shows the screening code as the reason for the visit but also shows the reason for the polyp removal.
 
On the ASC (facility) side, we always list the findings primary, as it is the most specific dx. relating to the procedure performed. I know many other ASC's do this as well, but on the Physician side and also Hospital side, they code the screening primary.
 
Donna SanGiovanni said:
On the ASC (facility) side, we always list the findings primary, as it is the most specific dx. relating to the procedure performed. I know many other ASC's do this as well, but on the Physician side and also Hospital side, they code the screening primary.
Click to expand...

I also work in an ASC and was dinged by an audit for coding the polyp as primary and screening as secondary. Can you tell me where I can find the information that an ASC should code the polyp as primary? Thanks:)
 
Another question along this line is do you code the findings such as a polyp or diverticulosis as primary and admitting diagnosis such as blood in stool as subsequent diagnosis? :confused:
 
colons

Screening

The American Cancer Society recommends colorectal screenings beginning at age 50 and more frequent or earlier screenings if you have other risk factors such as a family history of the disease. If a patient is seen for a screening colonoscopy or sigmoidoscopy, assign code V76.51 as the principal diagnosis. A screening test is looking for a disease in a seemingly well patient (eg, no signs or symptoms of the condition are present) so that detection and treatment can begin early in patients who test positive. Code V76.51 is used as the principal diagnosis even if a condition is identified during the screening test. A code for the condition may be sequenced as a secondary diagnosis (AHA Coding Clinic for ICD-9-CM, 2001, fourth quarter, pages 55-56).
 
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ASC Coding guidelines for dx

Documentation to support the ASC coding guidelines that you requested, are in the ICD9 code book under coding guidelines, Section IV, Diagnostic Coding and Reporting Guidelines for OP services, under the letter "O".

It states:

For ambulatory surgery, code the diagnosis for which the surgery was performed. IF the POSTOPERATIVE dx is known to be different from the preoperative dx at the time the diagnosis is confirmed, SELECT THE POSTOPERATIVE DX for coding since it is the most definitive.

I know every payor is different, but I would suggest you make sure you get something in writing from the payor to support doing it differently. I would also check with your audit company to find out what rules they were following when they dinged you.

Hope this helps
Mary
 
Medicare has recently sent out notification that the screening diagnosis should be coded as the primary and any additional findings be coded as secondary. This can be found in the Federal Register, Vol 71, No. 231, Page 69665, Dec 1 2006.
 
It is true that Medicare just announced (again) that they want the screening first and any findings secondary but if a biopsy or polyp is removed your diagnosis pointer has to point to the second diagnosis. I believe that someone earlier explained the whole diagnosis pointer thing. The article is on the CMS website under MLN Matters # SE0746.
 
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