Ok, so I thought I would throw out a few coding scenarios under the Affordable Care Act to see if anyone agrees/disagrees with me. Just needing a little acknowledgement if I am on the right track:

Background: Patient arrives and writes "routine screening" on the H&P. During meeting w/MD pt mentions some rectal bleeding and hemorrhoids in the past. MD bills E/M for bleeding and gives pt some tips on hem management. MD recommends colonoscopy for screening and rectal bleeding. Pt is then sched and undergoes colonoscopy......

1. Plain colonoscopy, hemorr only seen on scope. Pt has Medicare/Medicare HMO primary.....bill G0121, V76.51 or G0121 V76.51, 569.3, 455.2: I am on the fence about the rectal bleeding 569.3 as it is not the primary reason for the colonoscopy. The patient was asympomatic until MD started questioning their colorectal history/review of systems.

2. Polypectomy performed, Medicare/Medicare HMO Primary....45385-PT, V76.51, 211.3 (refernce DX2 on claim form)

3. Plain colonoscopy, hemorr only seen on scope. Pt has commerical ins primary.....bill 45378, V76.51, 569.3, 455.2

4. Polypectomy performed, Commerical Primary....45385, V76.51, 211.3, 455.2 (reference DX2 on claim form)

What do you think?