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Polyp w/screening colonoscopy

  1. #11
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    Medical Coding Books
    codeing guidelines define the difference between screening and diagnostic.

    Debra A. Mitchell, MSPH, CPC-H

  2. #12
    Default Found It! MLN Matters Number: MM2874
    This is some text from MLN MM2874: "Once every 48 months, one Flexible Sigmoidoscopy examination is covered for beneficiaries age 50 and over. If, during the course of a screening Flexible Sigmoidoscopy, a lesion or growth is detected which results in a biopsy or removal of a growth, the appropriate diagnostic procedure (such as Flexible Sigmoidoscopy with biopsy or removal) should be billed rather than just a Flexible Sigmoidoscopy examination. "

    This also means that the referring dr should have not given you a screening V-Code and should have given you the appropriate signs/symptoms DX. For which the biopsy or removal was done for.

    In general, all true AP specimens are derived from diagnostic procedures and thats all I have to say on the matter.

  3. #13
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    I totally under stand your position and it is all true for diagnostic studies.... HOWEVER if this is a screening then there are no signs or symptoms to report. Again this is the difference between screening and diagnositc. They are two very different issues and should not be confused. When a patient presents for screening they do so based on having met some prescribed criteria such as age, they have no symptoms and no reason to believe there are any issues. The same goes from the provider aspect , they exam a healthy patient with no complaints and order a screening, IF there are findings, they are incidental to what was expected ( a clean colon) and incidental findings are secondary. To report this any other way canbe/is damaging to the patient, benefits can be denied, premiums can go up. I am not saying that this affects how we code, rather we must always be correct with our coding because of how that affects the patient.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    Always if it is a Screening Colon you Code V76.51 followed by the findings. Read your CPT Assistance.

    Kimberly CPC
    Last edited by KimberlyLanier; 08-25-2010 at 02:07 PM.

  5. #15
    Default
    If you are looking for documentation on the subject you can go to CMS website to the MLNMatters article:

    http://www.cms.gov/MLNMattersArticle...ads/se0746.pdf

    There it describes it as the following:

    ``if during the course of such screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the lesion or growth, payment under this part shall not be made for the screening colonoscopy but shall be made for the procedure classified as a colonoscopy with such biopsy or removal.'' Based on this statutory language, in such instances the test or procedure is no longer classified as a ``screening test.'' Thus, the deductible would not be waived in such situations."

    Where the patient would have no deductible for a screening colonoscopy (V76.51), because something was sent to the pathologist (211.3 or 211.4), it is no longer screening and the deductible would be applied. Hope this helps.

  6. #16
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    Columbia, MO
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    They are talking about the procedure code not the diagnosis code. The diagnosis does not change from screening. The procedure code will be the colonoscopy with biopsy as it cannot be coded with the G code for the screening colonoscopy. Remeber the dx belongs to the patient and the coding guidelines specify " the diagnosis remains screening first listed regarless of the findings or a subsequent procedure performed."

    Debra A. Mitchell, MSPH, CPC-H

  7. #17
    Default
    Keep reading the article -

    it tells you to use V76.51 as the first code and 211.3 as the second code, but on the claim, link the pointer to the second dx only- which is 211.3.

  8. #18
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    Columbia, MO
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    Yes that is what I am saying, but you do not drop the screening dx code and you do not add any signs or symptoms, the procedure was for screening and the screening dx remains the first list dx code. The fact that the 211.3 is the number 2 dx code and carries that designation says this. If Medicare wants to not waive the deductible then so be it but other payers may be different, as long as th coding is correct we must let the payment fall where it naturally will fall.

    Debra A. Mitchell, MSPH, CPC-H

  9. #19
    Default
    Your ICD-9 coding maybe correct for the dr that performed the colonoscopy. But question for this post was for the ICD-9 coding for the pathologist. Per both the MLN Matters quoted here the procedure became diagnostic when the rendering dr decided to take a specimen. Per Medicare any diagnostic test that the pathologist performs and renders a definitive DX for; that DX should be used as the primary ICD-9 for said test. Which means the pathologist should report 211.3 for the specimen.

  10. #20
    Default
    I do not do pathology billing but what you are saying tomtom makes sense to me. Pathology is dealing with a polyp, therefore their coding has to do with the specimen. The specimen is not "screening" - the specimen is a polyp. Just my take on the situation.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

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