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Screening Colonoscopy w/HX of Chronic Constipation

  1. #1
    Default Screening Colonoscopy w/HX of Chronic Constipation
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    I've been reading the posts on Screening Colonoscopies and from what I'm able to gather a Medicare patient with a long history of constipation who has come in for a screening colonoscopy would have to be coded with 45378 and 564.00 rather than a G code and
    V76.51. I'm having trouble understanding why a history of constipation would preclude using the screening codes. Can anyone direct me to guidelines that would clarify this particular situation? Thanks.

  2. #2
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    I don't think Medicare covers 45378 for constipation...at least it is not on the TrailBlazer's LCD. I would code G0121/V76.51.

  3. #3
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    I agree with you and have always coded that way in the past. However, please see the 06/25/08 post titled "ICD squence for screening colonscopy" where the advise was never use V76.51 if the patient has symptoms, personal or family history.

  4. #4
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    depending on the documentation you may be able to use "change in bowel habits" 787.99

  5. #5
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    Long history of constipation would seem to preclude using change in bowel habits. What I'm trying to clarify if why that preoperative DX would not allow coding a screening colonoscopy which is what is being said in the 06/28/08 posting I referred to in my last response. The coder is saying any symptoms, personal or family history of a GE nature would not allow you to code a screening colonoscopy, which does not make sense to me. Family history seems to be a perfect reason for doing a screening.

  6. #6
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    I copied and pasted the response I think you are referring to here:

    "I do not feel it is appropriate and never use V7651 if the patient has a personal history or family history. We have insurances that do the same thing but it is important to use the history dx so the patient is justified in having their colo's sooner then somone who does not have a history. This same thing was addressed in a seminar I went to in March and the speaker stated that screening should only be used if there is no signs, symptoms, personal or family history. Hope this helps!"

    I disagree with this statement in part. I believe it is absolutely appropriate to code screening prior to "hx of" codes. History of is not a sign/symptom. You are screening to determine if; 1) the patient's family hx is currently an issue; or 2) if the patient's past history is currently an issue. Does that make sense?

  7. #7
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    It makes perfect sense. Let me ask another question. If what the doctor meant by HX of chronic constipation is that the patient is chronically constipated, would a DX of 564.00 not allow the use of
    V76.51 if the reason for the procedure is screening?

  8. #8
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    Quote Originally Posted by coderguy1939 View Post
    It makes perfect sense. Let me ask another question. If what the doctor meant by HX of chronic constipation is that the patient is chronically constipated, would a DX of 564.00 not allow the use of
    V76.51 if the reason for the procedure is screening?
    I don't see why you could not use V76.51. If the patient is chronically constiapted, isn't that more of a "normal" state for the patient? To me, screening would still be appropriate.

  9. #9
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    I agree and so I think that any and/or all pre-existing GE conditions should not necessarily exclude coding a screening colonoscopy. Thank you for all of your input.

  10. Default
    I agree with Lisa. Just because the patient is chronically constipated, doesn't mean the provider isn't doing a screening colonoscopy. I think that if I were coding this procedure, I'd be inclined to code as screening with the additional diagnosis of constipation.

    ~L
    CPC, CGSC, COSC

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