screening vs surveillance colonoscopy

katiejeanne

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Hey guys,
We have a younger patient (BCBS insurance) who has presented to our facility for multiple EGD procedures in the past. They have found gastric polyps each time. Now he presents again and had an EGD done then also a colonoscopy.
On the surgical order it states the diagnoses are "history of gastric polyps" then "screening colonoscopy". However, on the operative report his preoperative DX is "history of gastric polyps" then "need for colonoscopy based on history of gastric polyps, given the possibility of polyposis syndrome". So can I still use "screening" for the colonoscopy since he is not having any symptoms related to this? It sounds like the patient is at high risk for developing polyps so they are wanting to make sure there aren't any in the colon.
They did find gastric polyps again and performed snare polypectomies during the EGD but the colonoscopy was normal. Any ideas on how this should be coded?? Thanks in advance!
Katie, RHIT
 

scorrado

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Bridgewater, VA
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This is a tough one!!! I think you will have to use the hx of gastric polyps as your dx. That is the reason on the report so you have to go with it. It most definitely will get denied and then you will need to appeal it. Good Luck and let us know how it turns out.
 

Torilinne

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Denver CO
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V12.79 is for personal history of diseases of the digestive system. The polyps in the upper digestive system would still qualify for use of this code as well....wouldn't it? This code is legit for all my screening colonoscopies.

Good luck!

Torilinne
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katiejeanne

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Thanks for responding so quickly. According to the colonoscopy LCD they won't cover dx code V12.79 for this procedure. Thats another reason why I was kind of questioning it for the colonoscopy. This patient doesn't have Medicare but a lot of insurances kind of follow their rules. I think I will use V12.79 and see how it goes...thank you!
Katie
 
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