Wiki Surveilance vs. Screening Colonoscopy

[coochford]

When does a surveilance colonoscopy (V67.09) 45378, with a patient with a history of colon cancer (V10.05) go back to being a high risk screening colonoscopy? V76.51; G0105; V10.05.
I understand that Medicare states a screening colonoscopy can be done once (1) every 48 months for a high risk patient, but it is unclear at what point it goes from a follow-up for surveilance, back to a screening. LCD's aren't clear on this. Can anyone show me a definitive timeline? ie: after 10 years of no re-occurrence.....etc? How do you handle at your hospital?

 

[j.berkshire]

If you're referring to Medicare guidelines, the IOM #100-04, Chapter 18, Section 60 should answer all your questions. Medicare does not differentiate between screening and surveillance. In your example, a patient with V10.05 is a high risk criteria, eligible for the G0105 every 2 years. See http://www.cms.hhs.gov/manuals/downloads/clm104c18.pdf

 

[coochford]

thanks Jenny! I thought I read and understood the Medicare guidelines, I had a chart the other day that I coded. The patient had had colon cancer just over 10 years ago and was in for a colonoscopy. No symptoms. I coded it as a high risk screening. My lead coder corrected me and told me to change my admitting and principle DX's to V67.09 and my CPT code from G0105 to 45378 due to the fact that the patient had previously had colon cancer and our LCD's are not clear on when a follow-up surveilance colonoscopy can go back to being a high risk screening. When I went over the Medicare guidelines that I thought were pretty clear, she showed me an LCD that said that once an "issue" (cancer, polyps) had been diagnosed, follow-up colonoscopies would be just that. There seemed to be conflicting statements between Medicare and LCD's that we use to back us up, so I was attempting to see what other coder's experiences/practices were.

 

[fami]

V67.09

Good morning,

I have number of claims denied due to * ICD-9 V67.09 is not a covered service for the participant. The E&M level on different cliams are 99211, 99212, 99203.
Any advices where I should start?
Fami

 

[rachell1976]

If these are truly post-op follow ups, then you need to see if the patient is in a global period. If so- you can't bill an E/M for these visits anyway.

If they are not in a global, then you need to use DX for what condition you are treating/ following.

Or a Status code if it is for instance periodical follow up for a Gastric tube/ or a History code for a cancer.