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Colon screening / history

  1. Default Colon screening / history
    Medical Coding Books
    Can an op report contain both v76.51 and v12.72? We are having many patients come in for "screenings" on the schedule and when the report comes thru for billing, they have only v12.72 as the indication on the report. Some commercial carriers when the procedure is billed with the v12.72 charges co-insurance. What I wonder is if the report stated both codes, v76.51 and v12.72, if the patient would be under the ACA and get different benefits applied to the procedure by the insurance? Because the patient thinks, screening, screening, screening....Patient's train of thought is... I came in because it was time for a screening due to my age, and I happen to have history of polyps. Why isnt it "just a screening?, and why do I have to pay towards it."

  2. #2
    Default HX Polyps
    HX has been established that they have/had a polyp and pt comes back in for follow up on their history of polyps or has a benign/malig polyp removed. This is no longer a screening. It is a follow up... then code the follow up "other surgery" and the condition code (211.3 or HX) always go with local intermediary or insurance carrier rules.

  3. #3
    Default
    So what I am understanding from the reply is that any patient whom has a hx of a polyp you would code as a surviellance / follow up exam V67.05 regardless if MD is stating diagnosis of screening for colorectal cancer and it has been a number of years since a polyp has been removed? Are you saying that this applies even if a polyp is discovered? I have just come across this and I do not have a comfort level that I agree. I appreciate further input on this. In my specific case patient presents to PMD whom recommends screening colo as a provisional diagnosis. Patient has a history of a very small hyperplastic polyp being removed 7 years prior by another MD. history of polyp is documented within H&P and on op note. Polyp is discovered and removed path indicates hyperplastic. How do you feel this should be coded? Not medicare commercial insurance coverage with screening criteria in place and carrier recognizes 33 modifier.

  4. #4
    Location
    Charlotte, NC
    Posts
    534
    Default
    It is still a screening. In this case you don't need a modifier. Unless you are billing with a 45378 then you would use the 33.

    If your payor accepts the G codes and you have it in your contract you can use the G0105 with the V12.72.

    Otherwise, 45378, 33 modifier and then the V12.72 for a dx.

    Because it is preventative. You are screening to see if the pt currently has a malignancy in his/her lower intestine.

    V12.72 only shows they have a history of polyps. If they are not currently being treated for the polyps and it falls within the accepted time allowed, it is a screening.

    I should ask, was anything found during the screening? If so, here's an example:

    45385, mod 33, dx=v12.72, 211.3, 562.10

  5. #5
    Default
    According to coding guidelines in the front of your ICD-9 book it states that "personal hx codes explain a patient's past medical condition that no longer exists and is not receiving any treatment, but that has the potential for recurrence, and therefore may require continued monitoring." It also states that personal history codes can be used with follow -up codes and family hx codes can be used with screening codes. Because of how it is stated, I code personal hx as V12.72. I do not add screening since it states that it can not be used with personal hx codes. This is just how we handle this since we have documentation to back up how we code these scenarios.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  6. #6
    Default
    I agree that this would still be considered a screening. I recently found an informative article on the AGA website that addresses the issue of surveillance colonoscopies being considered high-risk screenings; also, the sequencing V12.72 and V76.51.

    Screening Versus Diagnostic Colonoscopy: What You, Your Patients and Referring Physicians Should Know
    Shannon, CPC, CCA

  7. #7
    Default
    I do agree that history of colon polyps should be considered high risk screening but not all commercial carriers recognize the G0105. As said on other threads and posts, it would be so much easier if everyone did it like Medicare.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  8. #8
    Location
    Charlotte, NC
    Posts
    534
    Default
    That's why you put the screening dx of V76.51 in the first slot to show the screening to the commercial carriers.

  9. #9
    Default
    I do not feel comfortable with putting V76.51 and V12.72 together since it states in coding guidelines that screening and personal hx codes cannot be used together. It states that family hx can be used with screening but not personal history. I would love to hear how someone else interprets these guidelines. I think they are pretty clear.
    Susie Corrado, CPC
    __________________
    ENT Coding/Billing

  10. #10
    Location
    Charlotte, NC
    Posts
    534
    Default
    Susie,

    I see what you're saying but you can read it a couple ways I guess.

    According to the ICD-CM Guidlines, page 22:

    "personal history codes may be used in conjunction with follow up codes."

    It doesn't say you can't use them with screening codes.

    If you look under screening it says you should use the "screening V code(V76.51 in this case) if that is what was planned".

    So if the docotr tells you they need to do a colon screening because of history of polyps, in my opinion, you would use the V76.51 code first because that is what is planned and then the V12.72 because that is why it is planned. That is only if you do not use the G codes though.

    Now if the payor accepts the G codes, even better. Then I would say G0105 with the
    V12.72. Because the G code is the inherent screening code.

    Also, maybe I'm missing it but where does it state you can't use V12.72 and a screening code together? I've read and re-read page 22 and the 2 sections regarding this discussion, section 4 and 5 and can't find that anywhere. Thanks!!
    Last edited by coachlang3; 11-21-2011 at 11:08 AM.

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