Wiki Surveillance colonoscopy vs screening

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cwharvey

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I am looking for guidelines outlining the difference between surveillance for previous hx of colon polyps versus screening colonoscopy. Also how are others coding this now? Thanks, Christine
 
Since we are to code to the highest specificity I code a patient who has a history of colon polyps as V1272. They are not "screening" (V7651) in my opinion. It is important to use that diagnosis so that the insurance companies allow the the patient to have their colonoscopies sooner than someone who does not have a history. Using the V7651 so the patient can use their "screening" benefits is a diservice to the patient and also is not the correct way to code this pariticular scenerio in my opinion.
 
Do you code for the physician?

Because I code for the facility that bills through a hospital, I cannot use V1272 as a principal dx; only as a secondary, so I would code V6709 followed by V1272. Do you get a lot of patient questions from this scenario? Do you know of any insurers who view it as screening over follow up?

Thanks
 
I do code for a physician.

Medicare will view V1272 as "high risk" screening. There are some commericial payors but it depends on the patients policy. For example - some blue cross policies view it as screening and others dont. We do get some that question it because they want us to put screening so they can use their screening benefits. But once they hear that it helps them get their colos sooner they are usually OK with the situation. Of course you always have those view that you can never satisfy. LOL!
 
Under the Medicare guidelines for the high risk colonoscopies, the V1272 is only to be used for history of adenomatous polyps. If the patient only had hypperplastic polyps, V1272 is an incorrect code and this should be considered a screening colonoscopy (V7651), subject to the 10 year limitations. Unfortunately a lot of physicians either don't tell you what type of polyps the patient had previously, or they ablated them on the original and have no idea what they were.
 
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