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Repeat colon

  1. #1
    Charlotte, NC
    Default Repeat colon
    Medical Coding Books
    Need some help folks.

    We had a pt come in in January 09 for a CCS. During the screening a very large polyp was found. Doctor removed as much as possible but dictated in his note that the pt may have to come in for a repeat exam in 6-12 months to make sure all the polyp was removed (pending path). Well, they called the pt to schedule a repeat exam.

    Pt had BCBS in January, now has Medicare. Our thought is to put a modifier 76 on the new claim. Someone else said we should have put a 52 mod on the original claim and now we should refile the original w/the 52 and the new claim should go w/no mod.

    Also, would we code it as a screening again? I would think diagnostic (as long as nothing was found this time). But we can't use the V code.

    Thoughts? Ideas?


  2. #2
    This is not really a screening, it's a follow-up/surveillance so V67.51 is inappropriate. If the colonoscopy is negative, you'd code V67.59 as the primary dx and V12.72 as the secondary dx. Some would say just coding V12.72 is allowable. If polyps are found you'd code the type of polyp as primary. Medicare and some commercial carriers have frequency limitations on screenings, BUT since you are not billing this as a screening you won't run into that problem. I code for ASC's so I'm not up on physician modifiers. If billing for the facililty side -76 would only be used if the same procedure was repeated on the same day. Hope this helps.
    Juanita Mendoza, CPC

  3. #3
    Milwaukee WI
    Default No modifiers needed
    You didn't need a 52 modifier on the first procedure because you actually performed all the procedure (DID in fact remove polyp ... or at least most of it).

    You don't need a 76 modifier because the colonoscopy has -0- global days so you don't need to worry about any global period (AND because first one was screening and this one is diagnostic).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Charlotte, NC
    Thanks Tessa, thats exactly the conclusion we came too.

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