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Screening vs procedure

  1. #1
    Location
    Lansing, Michigan
    Posts
    84
    Question Screening vs procedure
    Medical Coding Books
    We are billing BCBS of Michigan and the patient is scheduled for a screening colonoscopy. We end up doing several polyp removals. Do we bill the procedures with screening and second diagnoses of polys or do we bill with just the polyp removal? Thanks.

  2. #2
    Default
    I just had this situation also arise and according to my compliance department as long as the screening diagnosis is supported in the documations we bill the screening as prim dx and the polyp dx as 2nd.. hope this helps! We are seeing several other insurance's going this way.

  3. #3
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    We are also billing the screening code primary as long as it is stated in the operative report and using the polyp as secondary.
    Christina Lee Wagner, CPC, CPC-H

  4. #4
    Location
    Tacoma
    Posts
    22
    Default
    I code for these everyday, and when their scheduled for the screening, but while during the procedure they found something we code the findings as primary and the v-code as secondary.

  5. #5
    Default
    This answer can be found in your ICD-9 book. It reads: A screening code may be listed as primary if the reason for the visit is specifically the screening exam. If a condition is discovered during the screen, then the condition should be assigned as an additional dx.

    If the polyps were truly an incidental finding, then you should code the colonoscopy w/ polyp removal w/ screening primary and polyps secondary.

  6. Default
    The method that Medicare and other payors want to see for this type of scenario codes is to list the V76.51 as the primary DX code,then list for the polyp as #2. However when entering the charges you will want to sequence the Dx codes as 2,1 to the procedure, an example would be;
    #1 V76.51 #2 211.3
    CPT 45385 2,1 on the HCFA
    This shows the screening code as the reason for the visit but also shows the reason for the polyp removal.

  7. #7
    Default
    On the ASC (facility) side, we always list the findings primary, as it is the most specific dx. relating to the procedure performed. I know many other ASC's do this as well, but on the Physician side and also Hospital side, they code the screening primary.

  8. #8
    Default
    Quote Originally Posted by Donna SanGiovanni View Post
    On the ASC (facility) side, we always list the findings primary, as it is the most specific dx. relating to the procedure performed. I know many other ASC's do this as well, but on the Physician side and also Hospital side, they code the screening primary.
    I also work in an ASC and was dinged by an audit for coding the polyp as primary and screening as secondary. Can you tell me where I can find the information that an ASC should code the polyp as primary? Thanks

  9. #9
    Default
    Another question along this line is do you code the findings such as a polyp or diverticulosis as primary and admitting diagnosis such as blood in stool as subsequent diagnosis?

  10. #10
    Default colons
    Screening

    The American Cancer Society recommends colorectal screenings beginning at age 50 and more frequent or earlier screenings if you have other risk factors such as a family history of the disease. If a patient is seen for a screening colonoscopy or sigmoidoscopy, assign code V76.51 as the principal diagnosis. A screening test is looking for a disease in a seemingly well patient (eg, no signs or symptoms of the condition are present) so that detection and treatment can begin early in patients who test positive. Code V76.51 is used as the principal diagnosis even if a condition is identified during the screening test. A code for the condition may be sequenced as a secondary diagnosis (AHA Coding Clinic for ICD-9-CM, 2001, fourth quarter, pages 55-56).
    Last edited by codermcdreamy; 10-30-2007 at 03:45 PM.
    codermcdreamy CPC, CPC-H

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