Results 1 to 4 of 4

Diverticulosis and colonoscopies

  1. #1
    Default Diverticulosis and colonoscopies
    Medical Coding Books
    Can a physician bill for a screening colonoscopy for colorectal cancer (V76.51) if the patient has known diverticulosis? The patient's diverticulosis is noted on the H&P but the patient is being seen for a screening. On the indications for his op report the provider lists "screening" and he documents the colonoscopy. There may or may not be polyps removed and the diverticulosis is noted. There's some debate as to whether or not this can still be called a screening. Since the patient is not having signs or symptoms of what's being screened (cancer), should it still be considered screening? On the other hand, we don't have signs or symptoms but we do have a known disease before the colonoscopy. Does this make it diagnostic even if the intent by the physician was a screening? Any thoughts and references would be appreciated!
    Thanks,
    Sue
    Sue Vermette, CPC

  2. #2
    Default
    In my experience, it doesn't matter if the patient has a prior gastro condition, they could have any # of conditions, but that doesn't override the need to have the colon cancer screening. If the doc says that it is a screening, then it should be coded as such. The patient's intent for coming in was that of a screening, and this is what the guidelines state makes it codeable as a screening. The findings are incidental, and if a polyp is removed, you can still code the screening dx V76.51 as the prime dx for most payers.

  3. Default
    Quote Originally Posted by SUEV View Post
    Can a physician bill for a screening colonoscopy for colorectal cancer (V76.51) if the patient has known diverticulosis? The patient's diverticulosis is noted on the H&P but the patient is being seen for a screening. On the indications for his op report the provider lists "screening" and he documents the colonoscopy. There may or may not be polyps removed and the diverticulosis is noted. There's some debate as to whether or not this can still be called a screening. Since the patient is not having signs or symptoms of what's being screened (cancer), should it still be considered screening? On the other hand, we don't have signs or symptoms but we do have a known disease before the colonoscopy. Does this make it diagnostic even if the intent by the physician was a screening? Any thoughts and references would be appreciated!
    Thanks,
    Sue
    I would code it as a screening as long as the patient wasn't presenting with signs and symptoms related to the diverticulosis. I wouldn't, however, code it a screening just because the MD states so. For example: screening, rectal bleedand diarrhea listed as pre op Dxs.

  4. #4
    Default Great points
    There have been times when a provider has said "screening, extent of ulcerative colitis" and I had to explain that it was diagnostic due to the fact that he's investigating the UC. For those cases in which the patient comes in for a screening with a known condition but is asymptomatic, your responses have been very helpful.
    Thanks!
    Sue Vermette, CPC

Similar Threads

  1. Screening Colonoscopy w/diverticulosis
    By burgmeit in forum Gastroenterology
    Replies: 4
    Last Post: 12-20-2016, 02:32 PM
  2. Diverticulosis with diverticulitis?
    By jerijoa in forum Gastroenterology
    Replies: 2
    Last Post: 12-01-2015, 07:53 AM
  3. Diverticulosis-Coding Help
    By dianne38 in forum Auditing General Discussion
    Replies: 1
    Last Post: 11-21-2011, 07:11 PM
  4. diverticulosis vs rectal bleeding
    By maudys in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 04-09-2010, 06:00 PM
  5. Diverticulosis
    By donnar in forum Gastroenterology
    Replies: 2
    Last Post: 11-13-2009, 04:34 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.