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K63.5 vs D12.4 colon polyp

  1. #1
    Default K63.5 vs D12.4 colon polyp
    Medical Coding Books
    Can anyone tell me what the difference is between K63.5 and D12.4? I realize the D12.4 is a benign polyp but I am not sure the K63.5.What I am asking is Dr. performed a colonoscopy found a polyp in the descending colon retrieved polyp cold forcep...Which code would be used?

  2. #2
    use D12.4 when its an adenoma and K63.5 when its hyperplastic

  3. Default
    Based on what it says in the ICD-10 book, I thought if the path came back as hyperplastic polyp, I would use K63.5, regardless of location in the large intestine. And if the path came back as adenomatous polyp, then I would use the D12.{0-9 depending on location in the colon}.
    Does anyone have AMA/CPT/etc. documentation that addresses this issue?
    Thank you in advance for your help.

  4. #4
    Default ICD10 Polyps - Wait for Path
    With the specificity allowed in ICD10, it is best to wait for the pathology results when coding colon polyps.

    The D codes will allow you to identify adenomas and specific sites and will allow for surveillance colonoscopies more frequently than an unspecified or hyperplastic polyp.

    Per guidelines, hyperplastic polyps are 10 year surveillance and adenomas, based on size and or total # encountered, can be repeated sooner (2-5 years).
    Not sure how sophisticated the clinical editing libraries are at the current state of ICD10, but eventually, I expect us to see denials based on frequency and previous polyps reported (K vs. D).

  5. #5
    I understand that we should wait for Path report , however I code for anesthesiology and that has never really been protocol in the past. So I still feel at a loss here...Thank you everyone for your replies they have been very helpful.

  6. Default
    Quote Originally Posted by kdavis169 View Post
    I understand that we should wait for Path report , however I code for anesthesiology and that has never really been protocol in the past. So I still feel at a loss here...Thank you everyone for your replies they have been very helpful.
    IMO, this is definitely going to affect all the colonoscopy billings at some point. We bill for every aspect and we usually do not wait for the pathology either. For now we have been using the K63.5, but I know at some point in the near future we are going to have to change our ways and hold everything up for the pathology reports.

  7. #7
    An additional tidbit I learned of yesterday from one of the GI physicians I work for.

    He just got back from a GI seminar and stated there's discussion about left colon hyperplastic (large) polyps requiring more frequent surveillance and also due to potential error in pathology, the frequency of colonoscopy may also be changed and allowed more often when hyperplastic polyps are removed.

    Not sure how we'll be able to track these since the hyperplastic polyp category in ICD10 is not site specific or size specific. Should be interesting... maybe this will be one of the first ICD10 code expansions in the upcoming year.

  8. #8
    Very good Information...thank you everyone for the information you all have given

  9. Default Codes being bundled
    Can anyone tell me if these codes should be bundled 43277 and 43274?

  10. #10
    I agree with what was posted above, based on my research, D12 category should be used for adenomatous codes and K codes when the polyps are hyperplastic.

    But now I just read something that has me concerned. Does anyone else have subscription to the "Gastroenterology Coding Alerts" by The Coding Institute? They posted an article "Keep This Colonic Polyp Code Guide at Hand to Maximize Returns." On page 82, under the heading "Hyperplastic" the article states that you should report hyperplastic polyps with D12.0 - D12.9. This is the opposite of what I have learned, and is very alarming. Has anyone else read this?

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