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V12.72 Question

  1. Default V12.72 Question
    Medical Coding Books
    I was just reading the Medicare colonoscopy question regarding V12.72, and here's my question.

    Do you code The Hx of polyps when polyps are found during the scope?

    We had this discussion at work, and my supervisor stated that if they have polyps, it was no longer a "history" it is a current condition and we are not to code V12.72 if there are polyps found during the procedure.

    Comments anyone?

    We have been doing this for a while and are not having any problems as far as payment or complaints from patients regarding how it's coded.

  2. #2
    We always code V12.72 first and then the findings like 211.3. We never had any problems with Medicare as well.

  3. Default
    ok, what about this......

    never code v12.72 primary unless absolutely nothing is found.....

    So if diverticulosis is found on scope being done for hx of polyps, we are only to code the 562.10

    v12.72 may be used as the last diagnosis, but never primary unless absolutely normal scope.

  4. #4
    Charlotte, NC
    I'm curios MKJ, would you use V76.51 only as the prime dx then to show the conversion and then never use the other possible V codes?

    At the GI practice I'm at we use the appropriate screening dx code as prime
    (V76.51, V10.05, V16.0, V12.71 or V18.51) and then we put 45380 (or whichever) and then the 211.3 (or whichever) on the second line.

  5. Default
    For some reason my supervisor does not want V12.72 primary ever. She wants us to code V76.51 (if the provider thinks surveillance means screening) and the findings, 211.3, 562.10, etc. (if the provider thinks surveillance means diagnostic).

    Now I pointed out that ICD-9 guidelines state that Hx codes are to be used as the reason for an encounter when a condition needs to be monitored for recurrence and that to me that means V12.72 should be coded primary. She's not buying it. She only wants it coded last if no polyps are found and not at all if they are.

    I do not have a problem not coding hx when polyps are found, because I can see her point of the patient no longer having a history of is a current condition. And we have had no problems with insurance or patient complaints regarding such. I do have a problem not coding it primary when there are no polyps. (truthfully I have never changed my coding in this situation)

    The problem came up when other coders were diagnosis switching when patients complained saying that the insurance would pay if v12.72 was primary as the insurance looked at it as a screening code. She doesn't like that the insurance thinks of it as a screening code.

    I have never had to switch diagnoses because I coded correctly in the first place (screening for screening, history for history).

    I have no idea how the insurance has been handling the situation of V76.51 being coded primary when the patient's last screening was 2-5 years ago, because I am using the v12.72 when polyps are not found. (She does not want history at all if we are using V76.51)

    So that's the story.

  6. #6
    This information is from the Gastroenterology Coding Alert...2008 Vol 11, No.2:

    "if during the screening colonoscopy, the physician detects a lesion or growth that results in a biopsy or removal of the growth, you should bill the appropiarte diagnostic procedure, such as 45380 rather than G0121...You should retain the initial V code as the primary diagnosis, even if the physician finds and removes a polyp during the exam. Likewise, a patient who presents with a symptom that requires a colonoscopy must be coded diagnostic, not screening"

    Hope this helps!!!

  7. Default
    V12.72 is a history code not and technically not a screening code even though many payors liken it to a screening code. I would never be using G0121 for a patient with a history of polyps as we would be using G0105 because the patient is high-risk.

    Are you thinking we should be using the V12.72 for follow-up of polyps and not link it to the scope when polyps are found?

    If the scope says it is for screening we always use a screening is a screening is a screening. V12.72 is not used for a screening colonoscopy except for a Medicare High-risk patient when using the G0105.

    At least this is what our Supervisor is directing use to do. Provider says screening we are to code v76.51. Provider says surveillance, either code v76.51 if providers deems this a screening or findings only if provider deems this as a diagnostic scope. (providers discretion)

    G0121 vs. 45380, etc. is not an issue

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