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Colon screening / history

  1. #21
    Medical Coding Books
    I will have an answer for this next week. At least as far as Medicare Florida is concerned.
    I submitted around 400 visits in late October coded as V76.51 as the primary dx w/ various personal and family hx V-codes as secondaries. We dropped them on the 4th of November so hopefully we will know next week one way or the other.
    This debate rages through my office every two to three weeks.
    Last edited by Peter Davidyock; 11-25-2011 at 12:36 PM.

  2. #22
    Fayetteville, NC
    Several months ago our office got a fax from Blue Cross of North Carolina stating that if the patient had a history of colon polyps (or any other history that would lead to needing a colon check) as the main reason for a colonoscopy that we should be billing those with the screening diagnosis code primary.
    For further clarification I actually spoke with someone in their main office who is in charge of this change. She told me that if there was not a current sign or symptom that all colonoscopies would be considered screenings.
    I even used a couple of examples that seemed far-fetched to me like a history of colon polyps, history of colon cancer, history of breast cancer (for a patient to be screened earlier than the currently accepted age), family history of colon polyps, family history of colon cancer, etc. And she said screening, all of those reasons and any others that are not current symptoms, are screenings from now on.
    This has been a big debate in our office and obviously many others for quite some time. I actually like knowing how they want it. This has also helped cut down on angry patient calls when they get their bills because many family practice doctors will send them over for screenings because they have a history of polyps or colon cancer and they had no current symptoms and they were having to pay alot out of pocket for having a colonoscopy done.
    Since late August I have been coding my Medicare and Medicaid claims this way as well. So far they all seem to be paying the way they should.
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  3. #23
    Charlotte, NC
    Exactly Grintwig. That's what I had said earlier that BC of NC and UHC have told us.

    Now Medicare or Medicaid I wouldn't worry about those.

    Medicare as long as you use the correct G code (if there are no findings) you can use the history of codes just fine. And if there are findings just plop the 33 modifier and you're still fine.

    For Medicaid of NC, I'm not sure they care either way on the order of the dx, but they don't want G codes.

  4. #24
    Fayetteville, NC
    I should have said that I only use the G codes for Medicare
    We have never really had a problem with Medicare or Medicaid in regards to the screenings. Medicare will not pay for the set-up visit but that is common knowledge.
    North Carolina Medicaid does not want to pay for anything most of the time but that goes for all procedures
    It seems to me like most of the commercial payers at least in my area (or with subscribers in my area) all seem to be following the same policy as BC of NC.
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  5. #25
    Seacoast-Dover NH
    Hello All ~ I have been researching this very subject and found your thread. I also found this link that corraborates that you can use the V76.51 with the the V12.72 and use the V12.72 as primary since that is the indication for the high risk screening.

    Let me know what you think!

  6. Default Screening Vs. Diagnostic
    My physicians use an out patient facitility to do all of our procedures. This facility is responsible for all its billing. Over a year ago they changed their coding procedures. They decided to start coding all asymptomatic colonoscopies as screening using the V76.51 as the primary code and V12.72 or the findings as the secondary code. After some research with our commerical carriers I decided I would also change my coding policy. It is working great. Now due to change over in the coding staff the facility is once again changing its policy. The policy now is if a patient has ever had a polyp or are considered high risk they will not code the procedure with V76.51. I would love to simply continue to code all my procedures the way I do now but then my patients get stuck with huge hospital bills and that is not fair to them. Does anyone have any suggestions or better yet some guidelines I can print showing that a patient can indeed be considered high risk and still qualify for a V76.51?

  7. Default
    I contacted UHC of GA, BCBS of GA, Cigna, and Humana and pateints with V12.72 are not to be coded with V76.51 primary because of the shortened interval of the screenings is considered surveillance, not screening. These patients are having their colonoscopies every 2-5 years instead of 10. If you read these carriers UM guidlines they state that patients with a history of polyps will be considered surveillance and processed under med necc benefits instead of screening. There is actually several notes in the Affordable Care Act (read deep and click on the links) regarding colonoscopy screenings stating that patients with a personal history of cancer and/or adenomatous polyps are not covered as screenings.

    Also, ICD-9 guidelines state that family history codes are used with screening codes and that personal history codes are used with aftercare codes. ICD-9 is basically stating not to use V76.51 with V12.72. You can use V76.51 with V16.0.

    I would make sure the carriers give you something in writing regarding using V76.51 primary with V12.72 secondary. I have seen audits where the carrier reprocesses it as high risk with V12.72 primary, forcing money back to the carrier and pt resp.

    We have several 2 forms we give patients educating them prior to the procedure. They can be found on our website at The first is under "Colonoscopy: What You Need to Know" and the second is under patient forms under "Colonoscopy Notification Form."

    I fight with facilities, physicians, and patients all the time to get it right. I provide articles, carrier guidelines, etc to support coding. Eductaion is the best method.

    Thanks for letting me add my two cents!
    Anna Barnes, CPC, CEMC

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