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Coding Colon Screenings for Commercial Payors

  1. #1
    Default Coding Colon Screenings for Commercial Payors
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    A patient with a personal history of colon polyps (V12.72) but NO current symptoms comes in for a colonoscopy. During the colonoscopy a polyp is found. Would it be coded as a screening for commercial payors? Specifically, would it be coded as V76.51, 211.3

  2. #2
    Location
    Charlotte, NC
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    We would code it as V76.51, 211.3, V12.72. Depends on your contract with the payor.

  3. #3
    Location
    Columbia, MO
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    I agree with the codes suggested , but remember the diagnosis codes have no bearing on your contract, since this is the patient's diagnosis, the provider is the one that determines this and we code accordingly, the contract with the carrier can in no way affect our choice of dx code nor the order listed.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
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    We would code it as V12.72 211.3.

  5. #5
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    We code 211.3 and V12.72. It does state in the guidelines in the front of your ICD-9 book under history that personal history codes can be used with followup codes and family hx codes can be used with screening codes. Since it does not state that personal history can be used with screening codes I do not use screening codes with V12.72. Hope this helps!
    Susie Corrado, CPC
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    ENT Coding/Billing

  6. #6
    Location
    Charlotte, NC
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    Actually our local BCBS and UHC reps have told us and put it in writing they want the V76.51dx code put on all charges or they will not consider it a screening (high risk or otherwise). Now, the 33 modifier should have taken care of it, but we are getting denials back from those carriers about it's use.

    Why o why can't payors just follow Medicare, even if it is a different modifier.

    PS And the expalnation for my use of payor contract is the use of a G-code. I forgot to state that, lol.
    Last edited by coachlang3; 10-26-2011 at 10:39 AM.

  7. #7
    Location
    Charlotte, NC
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    534
    Cool
    lost control on this entry, lol

  8. #8
    Location
    Charlotte, NC
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    534
    Cool
    I also went into the guidelines and found this

    "A screening code may be the first listed code if the reason for the visit is specifically the screening exam."

    "Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis."

    "The V code indicates that a screening exam is planned."

    "The screening V code categories:

    V28
    V73-V82"

    So I still propose you can use the V76.51 as the first dx to show a screening was planned. The V12.72 is not a screening code it is a history code and the reason you are doing a screening. So unless you are using a G code, the CPT won't show it as a planned screening. Now if the sole reason you were doing a 45378 was due to the personal history than sure, you'd use the V12.72. But if you were planning on doing a screening because of the personal history? V76.51. Semantics? Sure. But it works within the guidelines.

    I still like the Medicare way though.

    I also am really starting to like the use of the smilies, lol

  9. #9
    Default Commercial screening
    What if the patient doesn't have a history of polyps, and the procedure is a screening during which diverticulosis is found? For Medicare, we code the admitting and primary as V76.51, all other diagnoses are listed after this. For all other insurances, the admitting and primary remain V76.51 if nothing is found on the examination. If something is found, it becomes the primay diagnosis. Any input is appreciated.

  10. #10
    Location
    Columbia, MO
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    12,571
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    Quote Originally Posted by Scatlot View Post
    What if the patient doesn't have a history of polyps, and the procedure is a screening during which diverticulosis is found? For Medicare, we code the admitting and primary as V76.51, all other diagnoses are listed after this. For all other insurances, the admitting and primary remain V76.51 if nothing is found on the examination. If something is found, it becomes the primay diagnosis. Any input is appreciated.
    The screening dx code remains first-listed regardless of the findings and this applies to all carriers not just Medicare. This is a diagnosis guideline not a payment guideline. The patient is asymptomatic and presents for screening, the finding is not expected and is incidental to the reason for the encounter therefore the encounter remains screening. Incidental findings are always listed secondary. The patient presented asymptomatic, you cannot indicate symptomatic after the fact. If the patient presents with a symptom say rectal bleeding and the finding then is diverticulitis then we can replace the symptom with the finding because you were specifically looking for the origin of the symptom and you found it. In a screening you have an asymptomatic patient for whom any findings are simple incidental to the presenting indication.
    Last edited by mitchellde; 11-03-2011 at 03:53 PM.

    Debra A. Mitchell, MSPH, CPC-H

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