Results 1 to 5 of 5

CPT versus HCPCS code on colonoscopy

  1. Default CPT versus HCPCS code on colonoscopy
    Medical Coding Books
    Colonoscopy scenario:

    Out patient colonoscopy. Medicare patient.

    Patient here for screening colonoscopy. No personal history. No family history. No symptoms.

    At time of procedure, patient found to have diverticula, but no polyps and no other abnormalities were found that resulted in a therapeutic procedure.

    Do you code:
    V76.51 x 2 – Special screening for malignant neoplasm, colon
    562.10 – Diverticulosis of colon (without mention of hemorrhage)

    45.23 – 45378 -- Colonoscopy, flexible, proximal to splenic flexure; diagnostic,
    with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)

    or

    45.23 – G0121 -- COLORECTAL CANCER SCREENING; COLONOSCOPY ON
    INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK (Special coverage
    Instructions apply)

    Basically, the question is: “Does the fact that the patient was found to have a positive finding (i.e. diverticulosis) that did not result in a therapeutic procedure make the difference as to which CPT code should be used?”

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Quote Originally Posted by jdoneske View Post
    Colonoscopy scenario:

    Out patient colonoscopy. Medicare patient.

    Patient here for screening colonoscopy. No personal history. No family history. No symptoms.

    At time of procedure, patient found to have diverticula, but no polyps and no other abnormalities were found that resulted in a therapeutic procedure.

    Do you code:
    V76.51 x 2 – Special screening for malignant neoplasm, colon
    562.10 – Diverticulosis of colon (without mention of hemorrhage)

    45.23 – 45378 -- Colonoscopy, flexible, proximal to splenic flexure; diagnostic,
    with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)

    or

    45.23 – G0121 -- COLORECTAL CANCER SCREENING; COLONOSCOPY ON
    INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK (Special coverage
    Instructions apply)

    Basically, the question is: “Does the fact that the patient was found to have a positive finding (i.e. diverticulosis) that did not result in a therapeutic procedure make the difference as to which CPT code should be used?”
    It was a screening and screening is what was performed... no other procedure was performed. The findings do not make this a diagnostic study. Code it as screening.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Athens, OH
    Posts
    27
    Default
    Our office has recently started billing these correctly after many discussions between our ASC and the hospital. The big insurance companies here, Medical Mutual, Anthem etc. have told us that if the patient comes in for strictly a screening colonoscopy that needs to be the first diagnosis listed in addition to any findings during the procedure. Also, if a biopsy or polypectomy is done on a patient that presented for screening, then the cpt code that is appropriate for the biopsy or polypectomy is listed with the first diagnosis of screening and then the polyp etc.
    RBoggs CMA, CGSC **Bloom where you are planted**

  4. #4
    Location
    Crystal Lake, IL
    Posts
    26
    Smile
    I agree with Mitchellde and RSBoggs...happy coding!

  5. #5
    Default Me Too
    Just for extra reinforcement, I agree too I've been doing ASC and gastro coding for 3 years, and what the previous coders have said is what I know of, glad to know I'm still on the right page too, it's always good to brush up constantly!

Similar Threads

  1. Screening Colonoscopy versus Surveillance Colonoscopy
    By wsoler in forum Gastroenterology
    Replies: 20
    Last Post: 06-16-2017, 12:41 PM
  2. CPT vs HCPCS Colonoscopy
    By SWEEETPEA1971 in forum Gastroenterology
    Replies: 1
    Last Post: 09-16-2015, 02:30 PM
  3. cpt/hcpcs code
    By atoma in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 12-05-2014, 11:53 AM
  4. CPT/HCPCS code 1073M
    By tlatte in forum Family Practice
    Replies: 3
    Last Post: 06-20-2013, 03:53 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.