Monday, November 15, 2010

colonoscopy billing CPT 45380 and teh DX V76.51 or 211.3

Colonoscopies are part of a check up for most individuals over the age of 50, however when the colonscopy finds a polyp, you should normally use the polyp diagnosis in your medical billing claim and not the screening V code. The exception to this rule would be if the physician discovers a polyp during the screening, you should instead report a diagnostic colonoscopy (45380, Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple). 

The coding changes for a situation where the surgeon visualizes and biopsies the polyp, you should change the primary diagnosis from V76.51 (Special screening for malignant neoplasms; colon) to, for instance, 211.3 (Benign neoplasm of other parts of digestive system; colon).

The majority of carriers have states they want to switch the polyp diagnosis for the excision a few want to keep the V code. If you’re not sure in your medical billing, avoid a delay or rejection by asking what the carrier’s preference is.

1 comment:

  1. Talk about bad information. You should read the official ICD 9 guidelines for coding and reporting: section 1 chapter 18 #5. It gives very explicit direction on screenings. The Coding Clinic (the authority on diagnosis coding) has also given direction on this matter.

    QUESTION: "Coding Clinic, Fourth Quarter 2001 advises the assignment of code V76.51, Special screening for malignant neoplasms, Colon, as the first-listed code when a patient with no personal history of gastrointestinal disease and no signs and symptoms has a screening colonoscopy performed that reveals a polyp. Is the code assignment different when the polyp is removed during a screening colonoscopy? It would seem that when a condition is found and treated, the procedure becomes a definitive procedure and is no longer a screening test.

    ANSWER: Whenever a screening examination is performed, the screening code is the first-listed code. The fact that the test is a screening examination remains, regardless of the findings or any procedure that is performed as a result of the findings. A screening is the testing for disease or disease precursors in a seemingly well individual so that early detection and treatment can be provided for those who test positive for the disease. The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test. A screening code may be a first listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an office visit for other health problems. Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis. This information is consistent with the Official Guidelines for Coding and Reporting (C18, 5. screening) previously published in Coding Clinic, Fourth Quarter 2002, pages 159-160."


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