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Screening Colonoscopy versus Surveillance Colonoscopy

  1. #11
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    Medical Coding Books
    What if the patient comes in w/ a routine screening V76.51 and the colonoscopy reveals Diverticulosis 562.10. Which code would come first?

  2. #12
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    Quote Originally Posted by rcclary View Post
    What if the patient comes in w/ a routine screening V76.51 and the colonoscopy reveals Diverticulosis 562.10. Which code would come first?
    you would list the dx on the claims as:
    1. v76.51
    2. 562.10

    BUT you would only link the 45378 to dx #2 (for the abnormal findings)

    http://www.cms.hhs.gov/MLNMattersArt...ads/SE0746.pdf
    Last edited by mad_one80; 02-04-2009 at 04:54 PM.

  3. #13
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    Quote Originally Posted by abenson View Post
    Pre-op dx is "Family hx of stomach and colon cancer, for surveilliance of colonoscopy and upper endoscopy."

    Post-Op dx: is "Gastritis, small hiatal hernia,internal hemorrhoids, polyp in the proximal ascending colon.

    What are the diagnosis I would use?
    I used 211.3 for the colonoscopy and 535.40 for the EGD but what about
    V16.0, would I use it and would it be primary or secondary?
    for the 45378 you would bill dx:
    1. v16.0
    2. 211.3
    3. 455.0
    link the 45378 to #2,3

    for the egd 43235/43239(biopsy) you would bill dx:
    1. v16.0
    2.535.40
    3. 553.3
    link it #2,3

    because the abnormal findings would be the fist linked dx but you still include the family hx dx

    http://www.cms.hhs.gov/MLNMattersArt...ads/SE0746.pdf
    Last edited by mad_one80; 02-04-2009 at 04:54 PM.

  4. #14
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    Indicate the Primary Diagnosis using the International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) code for the screening examination (colonoscopy or sigmoidoscopy), and
    • Indicate the Secondary Diagnosis using the ICD-9-CM code for the abnormal finding (polyp, etc.).
    For example, V76.51 (Special screening for malignant neoplasms, Colon) would be used as the first listed code, while the secondary code might be 211.3 (Benign neoplasm of other parts of digestive system, Colon).
    • Item 24D (Procedures, Services, or Supplies)
    • Indicate the procedure performed using the CMS Healthcare Common Procedure Coding System/Common Procedure Terminology (HCPCS/CPT) code for the procedure (biopsy or polypectomy), and
    • Item 24E (Diagnosis Pointer)
    • Enter only "2" (to link the procedure (polypectomy or biopsy) with the abnormal finding (polyp, etc.)

    http://www.cms.hhs.gov/MLNMattersArt...ads/SE0746.pdf

  5. Default
    I've already read the MLN article before I understand. What I'm trying to fnd out is does the V code actually go on the HCFA at all? I just don't get this linking thing. When I put it in my computer, it links it and that's it.
    adrianne, cpc

  6. #16
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    Greeley, Colorado
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    Yes, if the initial intent was for screening then V76.51 should be on the claim form.
    Lisa Bledsoe, CPC, CPMA

  7. Default screening colonoscopy with a history of colon polyp
    It is my understanding that ICD-9 Code V67.59 followed by V12.72 is most correct since it is a follow-up screening. The patient has already had an initial screening colonoscopy and polyps were found.

  8. #18
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    So I have something to say on this too...shocker! I agree with SCorrado, we need to code to the highest level of specificity that we can. This year marks my 5th year doing gastro coding, and I can honestly say that I have made some big changes in the way I do coding this year. I haven't had any payer problems because I think that when you do code to highest specificity, it is the most accurate reflection of what is going on. I think that you CAN code with a V76.51 and then the V12.72, but I don't think that is THE MOST correct way of doing things. If you want to be coding as close as you can to how it is supposed to be, you might want to review the section of the ICD-9 Book where it talks about screenings, there is a really good section on that subject in there. I can tell you that I feel much more confident that I am doing it the correct way since I started using speceficity as my guide. :0) I used to use the V76.51 a lot, and now, I use V12.72 and V16.0 a lot more. Not only do these codes more accurately reflect why the patient came in, but they also benefit the pt. as far as payer reimbursement goes, because even if they find something and a therapeutic procedure is done, the payers will still not apply to deductible for most pt's if they CAME IN for the purpose of a screening, or a follow-up on previous polyps. I have found this to be extremely effective. So here's an example:

    Polyp found, removed by snare in a pt. that came in because of a history of colon polyps:
    45385 - V12.72, 211.3...simple as that! and they WILL pay! I promise, I've billed like this for quite awhile, and haven't had ANY problems, I have very few patient calls, and I think it's the most accurate reflection of what happening.


    Look at me ramble on.. I'm done now..hope this is helpful, and not confusing!

  9. Default
    Thank you that was very helpful

  10. #20
    Default colonoscopy
    Quote Originally Posted by wsoler View Post
    It is my understanding that V12.72 is an unacceptable principle dx and can only be used as a secondary dx. The ongoing discussion between coders at our facility is that the principle dx should be 211.3, while others say it should be V76.51.
    V12.72 for surveillance due to previous polyps or cancer. V76.51 initial screening to pt . Code 211.3 cannot be principal dx because the patient is going through procedure. If polyps or cancer is found then the latter applies as a secondary dx.

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