It depends on the insurance. Most of the major carriers in my area are now advising us that if it started as a screening the primary diagnosis code on the procedure (45378, 45380, 45384, 45385, etc) should be the screening V code regardless of what is found. I guess since most of the carriers are not/were not accepting the screening modifier they had to give us some way to show what was actually going on.
According to Blue Cross of North Carolina now it is coded with the procedure code for what was found but the primary diagnosis code is the screening code V76.51. And in the event that they have a history of polyps or cancer but are currently exhibiting no signs or symptoms that would warrant a colonoscopy (such as rectal bleeding, diarrhea, abdominal pain, melena) it is still considered a screening.They faxed out an instruction sheet over the summer that stated if it started as a screening the primary diagnosis on the procedure regardless of the results would be the screening V code. And they are paying at 100% even though there are results. Now this is only if the patient has NO signs or symptoms what so ever when they come in to schedule the procedure regardless of their history.
I was a little confused by this so I called BCNC and spoke with the person in charge of this and she said that if the patient exhibited NO CURRENT symptoms that it is a screening. If during the procedure polyps or diverticulosis or whatever was found that the primary code should still be the screening V code followed by the diagnosis codes for what was found.
A. McCormick, CPC, CGSC
Walters Surgical Associates