AAPC - Back to school
Results 1 to 5 of 5

Thread: Medicare Screening Colonoscopies

  1. #1

    Question Medicare Screening Colonoscopies

    AAPC: Back to School
    When the provider states that the reason for the colonoscopy is "Screening for personal history of polyps" or "Screening for personal history of Colon Cancer" or "Screening for family history of Intestional Cancer".

    Should the V-code be primary or should the findings from the procedure be primary?

  2. #2
    Join Date
    Apr 2007
    Columbia, MO


    If you look at the coding guidelines they tell you that the screening V code should be listed first regardless of any findings. The findings are secondary. The findings are incidental to the the expectations in a diagnostic screening test. The expectation is that the findings will be negative because the patient has no problems or complaints. When Medicare states to drop the screening and code the diagnostic, they are referring to the HCPCs and CPT codes. The diagnosis code is the patient's.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3

    Red face Medicare Colonoscopies

    That answers part of my question.

    The part I still not sure about is if the provider states Screening for history of Colonic polyps V12.72, and the patient has no other signs or symptoms. Do I put the V12.72 as primary since the provider states "screening" or do I list what is found during the procedure and then the V12.72

  4. #4


    You need a screening code then findings if any then you can use the history.
    Screening v76.51
    history of polyps v12.72

  5. #5


    This really is not that difficult

    if patient comes in for screening only, v76.51, v12.72 or v16.0

    but the doctor finds a polyp in rectum and removes by snare, and a polyp in cecum and removes by cold forceps
    the correct billing is:

    45385, 45380-59 dx: v76.51(or whichever is appropriate for your pt)

    please make sure when you actually bill the claim that you do not designate a diagnosis pointer to your screening dx code

    45385 dx pointer will point at 569.0 only
    45380-59 dx pointer will point to 211.3 only

    medicare only wants the v code listed primary so that they know the intent of the procedure was for screening

    now--if nothing is found

    your code would be

    G0105 or G0121 (depending on low or high risk category)

    and dx would be v76.51 for g0121 or v16.0 for g0105

    thats all there is to it

    Caprice Walder, CPC

Similar Threads

  1. Screening coding for medicare colonoscopies
    By slimmagnum in forum Billing/Reimbursement
    Replies: 0
    Last Post: 10-05-2015, 09:39 AM
  2. Screening colonoscopies please help!
    By Tracy592 in forum Gastroenterology
    Replies: 2
    Last Post: 09-11-2012, 01:30 PM
  3. Screening colonoscopies
    By Colliemom in forum Gastroenterology
    Replies: 3
    Last Post: 02-07-2012, 02:01 PM
  4. Screening colonoscopies
    By Colliemom in forum Gastroenterology
    Replies: 6
    Last Post: 01-03-2011, 09:36 AM
  5. Screening Colonoscopies
    By bbeatty in forum Gastroenterology
    Replies: 8
    Last Post: 05-05-2010, 07:57 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.