Wiki screenings physician & facility coding


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Having some issues with patients coming to see the MD for screening colon, physician orders the colon as a screening and the patient has no other dx for the colon....physician performs the colon and it is normal other than he notices the patient to have a small hemorrhoid(which is not inflammed nor bleeding)... i coded it as a screening ( didnt think the hemorrhoid was relevant to the colon and some ins companys do not recognize as a medical necessity). The facility codes out a diagnositic (due to the small hemorrhoid)with out mention that the procedure was even orginiated as a screening.....even with the hemorrhoid should they have not used the V code and the 33 modifer???? I am confused as to even if the procedure turns out diagnositic should the facility also not be using the V codes and the modifer to reflect that the procedure orginates as a screening
For these we code as a screening code, 45378, G0121, G0105 with the screening diagnosis first and hemorrhoid secondary. I do not add a PT/33 to these for hemorrhoids. IF it becomes a 45380, 45385 then I do the screening code first, polyp code second and attach a PT/33.
I agree with rsboggs post re: coding. That is the way way we code, V code first, hemorr second. I have to argue and educate the facility coders all the time. It sounds like it is time to do more education on coding colonoscopies: diagnostic, screening, surveillance.

Anna Barnes, CPC, CEMC