Wiki V1272 vs 211.3

[BECKYPHILLIPS]

I code for a facility. Dr. Performs colonoscopy with scheduled dx v12.72. Polyp is found and removed 45385. I billed 211.3/v12.72 dr. Office billed
v12.72/211.3 and were paid 100%. I can not find documentation that states v12.72 would be used as the primary code. The word screening was never used in the op report. I need input please.

 

[tpontillo]

The way the dr's office billed is correct. You would code the reason for the colon as primary and then any findings would be secondary. I have attached a link for you:

http://health-information.advanceweb.com/Article/Understanding-How-to-Code-Colonoscopies.aspx

 

[blathrop19@gmail.com]

Also on top of what tpontillo said, the best practice I have seen is to code the V12.72 as primary and then if your software allows for diagnosis pointers you should point to the 211.3 first for the 45385 so that on a claim it shows 2,1 on the line item. If anyone thinks that is wrong let me know.

Bob

 

[BECKYPHILLIPS]

V12.72 vs 211.3

Thanks for the input. I do not see anywhere in this article that answers my question. I find the physician and facility have different views, especially on the research i have gathered. We bill what was found if not a screening.

 

[eadun2000]

Thanks for the input. I do not see anywhere in this article that answers my question. I find the physician and facility have different views, especially on the research i have gathered. We bill what was found if not a screening.

Apparently you read over this but didn't see it. It says:

1. A patient is seen in the outpatient clinic for colonoscopy due to family history of colon cancer. The patient has no personal history of gastrointestinal disease and is currently without signs and symptoms. The colonoscopy revealed a colonic polyp that was removed by snare technique. How should the diagnoses and CPT procedures for this case be coded?

a. 211.3, V76.51, V16.0, 45385

b. 211.3, V76.51, V16.0, G0105

c. V76.51, V16.0, 211.3, 45385

d. V76.51, V16.0, 211.3, G0105

e. V16.0, 211.3, V76.51, G010

Answers to CCS PREP!:

1. c.Assign code V76.51, Special screening for malignant neoplasms, colon, as the first-listed diagnosis because this was a screening colonoscopy. Code V16.0, Family history of malignant neoplasm, gastrointestinal tract, may be assigned as an additional diagnosis. Assign code 211.3, Benign neoplasm of colon as an additional diagnosis. Because the polyp was removed, 45385 is reported to identify the definitive procedure performed.

As you can see for a screening colonoscopy, you code the screening code first, followed by what was seen second. Hope this helps.

Em

 

[capricew]

And dont forget the new modifiers this year!

If this is a medicare patient then you need modifier - pt after 45385
for commercial insurance then you use modifier -33

these modifiers tell the payer that even though a surgical code is being billed, the procedure initiated as a screening

 

[kgodda1]

I code for a facility. Dr. Performs colonoscopy with scheduled dx v12.72. Polyp is found and removed 45385. I billed 211.3/v12.72 dr. Office billed
v12.72/211.3 and were paid 100%. I can not find documentation that states v12.72 would be used as the primary code. The word screening was never used in the op report. I need input please.

Since you code for the facility, you would have to note that V12.72 is not acceptable as a prinicipal diagnosis. If I was coding this case for the facility, I would code it as 211.3 then V12.72. If you tried to bill with the V code as primary, your claims scrubber would likely throw an edit and hold up the claim.

 

[mitchellde]

Since you code for the facility, you would have to note that V12.72 is not acceptable as a prinicipal diagnosis. If I was coding this case for the facility, I would code it as 211.3 then V12.72. If you tried to bill with the V code as primary, your claims scrubber would likely throw an edit and hold up the claim.

Where is it stated that V12.xx codes cannot be used as primary? The guidelines state these are acceptable as either primary or secondary and that is facility or physician.

 

[blathrop19@gmail.com]

Yeah that's new to me too. I have seen payer specific rules where V codes cannot be first, but not facility/physician.

 

[magnolia1]

I know this is an old post, but..........

Tabular list in ICD-9 shows V12.72 as an Unacceptable PDX

 

[mitchellde]

Personal hx codes specifically V10 and V12 codes can be either first or secondary codes there is no restriction. I am not sure what version of the code book you have that says that but always defer to the guidelines, there is nothing in the guidelines that state this and my code book has no instruction stating they cannot be primary.