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Thread: colonoscopies

  1. #1
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    Apr 2007
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    Salt Lake City
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    74

    Default colonoscopies

    Someone comes in for a rountine exam, has a family hx of colon polyps and nothing is found except for unspecified internal hemorrhoids and diverticulosis. Will the dx codes for the hemorroids and diverticulosis change the value of the screening? And how important is it to code those two along with the V76.51 and the V18.51?
    codermcdreamy CPC, CPC-H

  2. #2
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    Virginia
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    Default

    Proper coding would be the reason for the procedure coded first and then any findings. Now, that said - every office and insurances have their own policies on this so you might want to check with the insurances that you encounter the most and see what they prefer.

  3. #3
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    Are you coding for the physician or facility? If its an ASC, the rules are different according to the ICD9 book.

  4. #4
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    Bay City
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    I dont believe that the findings would change the value of the procedure but in my experience its actually rather important to code the findings as well as the screening codes. In the scenario that you presented, the diverticulosis would mean that the patient would be, by certain insurance carrier standards, eligible to have a colonoscopy done at a more frequent interval than someone with no symptoms or history.

  5. #5
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    Palm Beach
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    You should code for the screening as primary and the others as secondary and additional diagnosis. For an ASC, it will not change the value.

  6. #6

    Red face

    Hi!

    In my experience, I have not been able to use the screening code. I am in Michigan and I found that the carriers here do not like it. The best advice that I can give is to check your LCD for Colonoscopies/Sigmoidoscopies for Medicare especially. It should have all of the ICD-9 codes that you can use listed on there. I am not saying don't use the screening, rather just make sure it appropriate for your area. Also, beware of using hemmorhoid codes too! This Dx code is excluded from the LCD list for Michigan. We can't use it at all. Medicare won't pay and (of course) all the other payers follow. However, definitely use your diverticulosis codes, polyps, etc., if the doc documents them. I hope this helps...

    Felicia Copeny, CPC-A

  7. #7
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    Apr 2007
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    Las Vegas
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    Default

    was any of this discussed during the patient's first visit? If the patient has diverticulosis/diverticulitis, they usually have signs/symptoms (bouts of diarrhea, abdominal pain, etc.) if so, then it is no longer a screening colonoscopy, but a diagnostic one. As for the hemorrhoids, I have been using those codes for my scopes and they have been getting paid. However, if they just have a screening scope, and the doctor said that the pt had a normal colon, then I would use the screening code as well as the family hx code. But, from my understanding, once you have a disease present, you code the disease b/c that is what your doctor is going to be follwing up on in the office.
    hope that this helps!
    Malama pono,

    Sundae Yomes
    CPC, CPMA, CEMC, CGIC, CGSC, CCS-P

  8. #8

    Default

    You may want to check with your Medicare carrier, because CMS published their guidelines in Oct or Nov 07 explaining, clarifying how it should be done. Per MC, if it started as a screening, the primary diagnosis should be screening. This is due to patients are not suppose to pay a deductible on screening colonoscopies.


    Quote Originally Posted by fcopeny View Post
    Hi!

    In my experience, I have not been able to use the screening code. I am in Michigan and I found that the carriers here do not like it. The best advice that I can give is to check your LCD for Colonoscopies/Sigmoidoscopies for Medicare especially. It should have all of the ICD-9 codes that you can use listed on there. I am not saying don't use the screening, rather just make sure it appropriate for your area. Also, beware of using hemmorhoid codes too! This Dx code is excluded from the LCD list for Michigan. We can't use it at all. Medicare won't pay and (of course) all the other payers follow. However, definitely use your diverticulosis codes, polyps, etc., if the doc documents them. I hope this helps...

    Felicia Copeny, CPC-A

  9. #9
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    Apr 2007
    Location
    Stuart
    Posts
    322

    Default

    Starting January 1, 2007 Medicare deductible is not waived IF the colorectal cancer screening test BECOMES a DIAGNOSTIC colorectal test, that is the service actually results in a biopsy or removal of a lesion or growth. You may find this information under the MLN Matters Number:SE0710 of the Medicare Website

    Hope this helps!!!
    nORaM

  10. #10
    Join Date
    Apr 2007
    Location
    Danville
    Posts
    26

    Default High Risk

    Hi. According to MCR guidelines, the patient would be considered High Risk due to family hx of colon polyps. The primary dx should be V76.51 , V18.51, and additional dx codes for the hemorroids and diverticulosis. The HCPCS code should be G0105.

    See the following CPT Assistant:
    JAN 2004, Volume 14, Issue 1; pgs 4-7

    AHA Coding Clinic:
    1Q, 1995, Volume 12, Number 1, Page 4
    1Q, 2004, Volume 21, Number 1, pgs 11-12

    Also search under your MCR carrier for colonscopy guidelines due to carrier discretion.
    For example http://www.highmarkmedicareservices....b/g1/g36g.html

    Thanks,

    Christy
    CPC, RHIT



    Quote Originally Posted by codermcdreamy View Post
    Someone comes in for a rountine exam, has a family hx of colon polyps and nothing is found except for unspecified internal hemorrhoids and diverticulosis. Will the dx codes for the hemorroids and diverticulosis change the value of the screening? And how important is it to code those two along with the V76.51 and the V18.51?

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