# Dx for colonoscopies



## bethh05 (Dec 15, 2008)

I have been coding colonoscopies for an ASC for a while. All the reading I have done states to use the V76.51 first, if the patient comes in for a screening, even if it turns into a biopsy. Some insurances are denying the 45380, 45384 or 45385 with the V code even with 211.3 secondary. Any suggestions would be greatly appreciated!


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## debaloia (Dec 15, 2008)

When a pt schedules for a screening colonoscopy and the doctor finds polyps the colonoscopy is no longer considered a screening.  I would use the code for the appropriate colonoscopy type ie:  45384 and 211.3 as primary. The finding on exam should be primary then the reason of the visit, so the v code would be secondary.  Hope this helps.

Debbie


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## amy_mousie (Dec 15, 2008)

*correct*

that is also my understanding - I believe you can have the screening code as a second dx but since the polyps were found it would be the prim dx and therefore no longer considered a screening so you would be coding the diagnosis and not screening.


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## bethh05 (Dec 15, 2008)

Thank you!


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## code3jill (Dec 16, 2008)

If anything other than a screening is done, you must code the dx from lab, bx or polypectomy result.  Screening is only for no findings.


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## coachlang3 (Dec 16, 2008)

*RE: DX for colon*

I've had a different experience.

We put the screening dx first to show it was meant for a screening and then on the second line we put the proc and the polyp dx to show the conversion.  This shows up correctly on a HCFA but on a UB the actual proc shows on the line and the V code shows as first dx and the 211.3 shows as secondary.  We 've encountered the occasional issue but not on a consistent basis and rarely from the same insurance.

The screening is still a screening converted to a diagnostic though since the pt did not present with symptoms but polyps were found.

Just what I've seen from our practice in NC though.

edit:  I'm basing this on CMS standards set forth from the MLN Matters # SE0746.  In the article it states:

"CMS advises that, whether or not an abnormality is found, if a service to a Medicare beneficiary starts out as a screening exam (colon or sigmoid), then the primary dx should be indicated on the form CMS-1500 (or its electronic equivalent) using the ICD-9 code for the screening examination.


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## elenax (Dec 17, 2008)

I agree with coachlang3: for Medicare you code first the screening diagnosis and the findings second: please read the following:

(*This is the way it was before*) when 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), as outlined in the instructions CMS provided in February.

*The retraction*: *Now,* CMS officials are distancing themselves from their earlier instruction, pointing to language in the ICD-9 diagnosis coding guidelines that state that *you should still use the screening diagnosis even if you find a problem during a screening exam.*
 
"Should a condition be discovered during the screening, then the code for the condition may be assigned as an* additional diagnosis*," according to ICD-9 instructions.
 
*Possible solution:* Some experts have recommended *listing the V code as the primary diagnosis in Box 21* of the claim form, but then *including a "2" next to the procedure code in Box 24.* This will let the *carriers know that the secondary diagnosis, the polyp code, is the one that they should associate with the procedure code*. Cobuzzi warns, however, that this won't work with most billing software. 

hope this helps!!!


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