Wednesday, June 29, 2016

Polypectomy Performed During Screening Endoscopy - billing Guideline

There are also times when the provider, while performing a screening colonoscopy, finds an abnormality that is removed. CMS coding guidelines indicate:

“If during the course of such screening colonoscopy, a lesion or growth is detected which results in a biopsy or removal of the lesion or growth, payment under this part shall not be made for the screening colonoscopy but shall be made for the procedure classified as a colonoscopy with such biopsy or removal.”

The appropriate CPT code for the surgical endoscopy should be reported on the claim. Furthermore, the initial diagnosis should be the appropriate V code for the screening service since that is the primary reason why the encounter was performed. A second ICD-9-CM code indicating the finding should also be reported.

For example, if the patient undergoes a screening colonoscopy and a polyp is found and removed by snare, this would be reported as shown on the following page:

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