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V1272 vs 211.3

  1. Default V1272 vs 211.3
    Medical Coding Books
    I code for a facility. Dr. Performs colonoscopy with scheduled dx v12.72. Polyp is found and removed 45385. I billed 211.3/v12.72 dr. Office billed
    v12.72/211.3 and were paid 100%. I can not find documentation that states v12.72 would be used as the primary code. The word screening was never used in the op report. I need input please.

  2. #2
    Location
    Lauderdale Lakes
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    The way the dr's office billed is correct. You would code the reason for the colon as primary and then any findings would be secondary. I have attached a link for you:

    http://health-information.advanceweb...noscopies.aspx

  3. Default
    Also on top of what tpontillo said, the best practice I have seen is to code the V12.72 as primary and then if your software allows for diagnosis pointers you should point to the 211.3 first for the 45385 so that on a claim it shows 2,1 on the line item. If anyone thinks that is wrong let me know.

    Bob

  4. Default V12.72 vs 211.3
    Thanks for the input. I do not see anywhere in this article that answers my question. I find the physician and facility have different views, especially on the research i have gathered. We bill what was found if not a screening.

  5. Default
    Quote Originally Posted by BECKYPHILLIPS View Post
    Thanks for the input. I do not see anywhere in this article that answers my question. I find the physician and facility have different views, especially on the research i have gathered. We bill what was found if not a screening.
    Apparently you read over this but didn't see it. It says:

    1. A patient is seen in the outpatient clinic for colonoscopy due to family history of colon cancer. The patient has no personal history of gastrointestinal disease and is currently without signs and symptoms. The colonoscopy revealed a colonic polyp that was removed by snare technique. How should the diagnoses and CPT procedures for this case be coded?

    a. 211.3, V76.51, V16.0, 45385

    b. 211.3, V76.51, V16.0, G0105

    c. V76.51, V16.0, 211.3, 45385

    d. V76.51, V16.0, 211.3, G0105

    e. V16.0, 211.3, V76.51, G010

    Answers to CCS PREP!:

    1. c.Assign code V76.51, Special screening for malignant neoplasms, colon, as the first-listed diagnosis because this was a screening colonoscopy. Code V16.0, Family history of malignant neoplasm, gastrointestinal tract, may be assigned as an additional diagnosis. Assign code 211.3, Benign neoplasm of colon as an additional diagnosis. Because the polyp was removed, 45385 is reported to identify the definitive procedure performed.

    As you can see for a screening colonoscopy, you code the screening code first, followed by what was seen second. Hope this helps.

    Em

  6. Wink
    And dont forget the new modifiers this year!

    If this is a medicare patient then you need modifier - pt after 45385
    for commercial insurance then you use modifier -33

    these modifiers tell the payer that even though a surgical code is being billed, the procedure initiated as a screening

  7. Default
    Quote Originally Posted by BECKYPHILLIPS View Post
    I code for a facility. Dr. Performs colonoscopy with scheduled dx v12.72. Polyp is found and removed 45385. I billed 211.3/v12.72 dr. Office billed
    v12.72/211.3 and were paid 100%. I can not find documentation that states v12.72 would be used as the primary code. The word screening was never used in the op report. I need input please.

    Since you code for the facility, you would have to note that V12.72 is not acceptable as a prinicipal diagnosis. If I was coding this case for the facility, I would code it as 211.3 then V12.72. If you tried to bill with the V code as primary, your claims scrubber would likely throw an edit and hold up the claim.

  8. #8
    Location
    Columbia, MO
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    12,837
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    Quote Originally Posted by kgodda1 View Post
    Since you code for the facility, you would have to note that V12.72 is not acceptable as a prinicipal diagnosis. If I was coding this case for the facility, I would code it as 211.3 then V12.72. If you tried to bill with the V code as primary, your claims scrubber would likely throw an edit and hold up the claim.
    Where is it stated that V12.xx codes cannot be used as primary? The guidelines state these are acceptable as either primary or secondary and that is facility or physician.

    Debra A. Mitchell, MSPH, CPC-H

  9. Default
    Yeah that's new to me too. I have seen payer specific rules where V codes cannot be first, but not facility/physician.

  10. #10
    Location
    Albany, New York
    Posts
    457
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    I know this is an old post, but..........

    Tabular list in ICD-9 shows V12.72 as an Unacceptable PDX
    Karen Maloney, CPC
    Data Quality Specialist

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