Page 1 of 3 123 LastLast
Results 1 to 10 of 28

Polyp w/screening colonoscopy

  1. Question Polyp w/screening colonoscopy
    Medical Coding Books
    We have been using dx 211.3 for adenomatous polyps when found on screening colonoscopy. Recently, we have had several patients complain that if we had coded it V76.51 first and 211.3 second, their insurance would cover the charge under their preventative benefits. Although the procedure may have begun as a screening procedure, I believe the pathology should be medical. Can anyone direct me to any literature about this or tell me how they handle this situation? Thank you for your help.

  2. Default
    Yes..i use v7651 first if documented as a sceening and then the finding such as 211.3

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Yes the screening is always first when the purpose of the test is screening regardless of the findings. The coding guidelines state this as well.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default
    I'm sorry but the correct DX is 211.3 not the screening code. “The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening.” (ICD-9-CM 2008, pg. 71 or 74)

  5. #5
    Location
    Columbia, MO
    Posts
    12,531
    Default
    I agree tomtom, however the original post stated this was a screening colonoscopy wich is not diagnostic. The guidelines also specify that when the pupose is a screening exam the first listed code remains screening regardless of the findings or any subsequent procedure performed. So if it were screenng there is nothing suspected and there are no symptoms. That is essentially the difference between screening and diagnostic.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Default
    Guidance states that the attending physician should report the V-code as the primary diagnosis, that direction does not carry through to the pathologist. The pathologist received the polyp for diagnostic testing. Which I would then refer you to my last post regarding testing of a person to rule out or confirm a suspected diagnosis.

  7. #7
    Location
    Columbia, MO
    Posts
    12,531
    Default
    there are no separate diagnosis guidelines for the pathologist, it was still screening. The specimen was a result of a screening not a diagnostic.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
    Default
    Per Medicare - the principal diagnosis to report on pathology services (TC or PC) is the pathologist's diagnosis if one can be rendered. The pathologist made a definitive pathologic diagnosis of adenomatous polyps.

  9. #9
    Location
    Columbia, MO
    Posts
    12,531
    Default
    That is correct for diagnostic studies. This was screening not diagnostic.

    Debra A. Mitchell, MSPH, CPC-H

  10. Default
    Thank you for your input; I can see the views from both aspects. I have tried to find literature on this subject with no success. Can you direct me where I can find it--NCD, etc?

Page 1 of 3 123 LastLast

Similar Threads

  1. screening colon no polyp
    By broyal@sc.rr.com in forum Gastroenterology
    Replies: 2
    Last Post: 10-13-2015, 04:19 PM
  2. Colonscopy/screening/polyp
    By rdavies in forum Gastroenterology
    Replies: 1
    Last Post: 06-10-2014, 07:17 PM
  3. Coding for polyp not retrieved during colonoscopy
    By Hite in forum Gastroenterology
    Replies: 7
    Last Post: 05-13-2014, 05:37 PM
  4. Colonoscopy with Polyp Removal
    By tfrick2 in forum Gastroenterology
    Replies: 5
    Last Post: 08-13-2012, 09:10 PM
  5. polyp removal during screening
    By codegirl0422 in forum Gastroenterology
    Replies: 7
    Last Post: 05-05-2008, 11:56 PM

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?

Login

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.