Wiki Short recall colonoscopy coding

[ngastroent]

How do you guys code if a Medicare patient is told to come back in 1 year as the doctor wants to recheck a specific area for regrowth? When I was trained in, I was told to only code that specific polyp as obviously "history of" will cause an automatic denial. Example:

-6/1/21: colon with snare removal in ascending for history of polyps I'd use 45385-PT with diagnoses of Z86.010, D12.2

-6/1/22: doctor request for repeat colon due to previous procedure: 45378 with diagnosis of D12.2
(no new tissue to remove or other polyps found)

Technically it is history of polyps, so the facility has been still billing it that way and getting denials. In my opinion it's OK to bill it diagnostically as he's really checking on that old polyp, but they're wondering if it could cause issues if a coding audit is done. How would you guys code this situation?

 

[mconner001]

We code it as a diagnostic (D12.2) since, as you say, they are really checking on a polyp. Hopefully the notes indicate why they need to do so, incomplete removal, etc.

 

[ngastroent]

We code it as a diagnostic (D12.2) since, as you say, they are really checking on a polyp. Hopefully the notes indicate why they need to do so, incomplete removal, etc.

Thank you!