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facility coding for colonoscopy

  1. Default facility coding for colonoscopy
    Medical Coding Books
    A Medicare patient comes in for a screening colonoscopy, a lesion is found and a biopsy is done, the screening is now a diagnostic. On the facility side
    do we still code the V76.51 primary?

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
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    The dx code remains screening first listed with the finding secondary, you do change the procedure code to diagnostic. This rule does not change just because you are the facility. This dx guideline goes across the board.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    my problem is the LCD 29795 for cpt code 45380 does not have V76.51 as a covered diagnosis code to meet medical necessity. Is anybody else having an issue with this?

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
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    and that may be true, and if this is a Medicare patient then the patient may be responsible. We do not assign dx codes for reimbursement we assign the dx code to meet the physician's documentation of the patient's condition which necessitated the procedure. The patient had no complaints or problems which indicated the medical need for the procedure, therefore it is screening and the patient may not be covered for preventive screening procedures so you bill the patient. Any dx found while performing the screening is incidental to why the patient had the procedure in the first place and incidental findings are secondary dx. Also the ICD-9 coding guideliends stated that when the reason for the procedure is screening then screening remains the first-listed dx regardless of the findings or subsequent procedurs performed. The facility should have an ABN for this where the patient agreed to any subsequent procedures.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Charlotte, NC
    Posts
    534
    Default
    It should be fine.

    We see this all the time and I've never coded it any other way.

    This is how our software makes it look:

    Dx V76.51
    45380 211.3(or whatever your lesion code is)

    The Dx you see we put in the proc slot to show as prime dx and that the procedure converted.

    The actual screening dx is not accepted with the 45380, but that's why you show the conversion.

  6. #6
    Default
    We have been billing medicare when is a screening with 45380(84 or 85) + v76.51 + 211.3 when applicable and we get pay as long as the finding(211.3) is listed as secondary dx
    NoRaX

  7. #7
    Default
    Who is the Medicare carrier?
    Juanita Mendoza, CPC

  8. #8
    Default
    This website will take you to an article from the Medicare Learning Network that may help with your question.

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

    It's really a matter of DX linkage when a screening colo becomes diagnostic.

  9. Default
    Debra-We have a coder that puts V76.51 as the primary dx in Box 21(on the claim) along with 211.3 and 569.0. If the physician removes a polyp then she puts 211.3, 569.0, V76.51 as the diagnosis pointers. I disagree with her, shouldn't the pointers reflect V76.51, 211.3 and then 569.0? Your opinion please. Tina-CPC

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