# 45385 colon/polyp



## Lbooth110 (Mar 2, 2013)

I'm trying so hard to understand when the V76.51 (screening code for colonoscopy) is appropriate to be used as the primary dx code. 

Our BCBS patient was scheduled for a colonoscopy  screening. The doctor end up doing a colonoscopy with a snare polypectomy 45385.  Wouldn't the "primary" dx code be the path report of the colon polyp and not the screening code?

I've been told the screeing code goes first, this does not seem right to me.

Please help! 
Z


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## mitchellde (Mar 2, 2013)

when the reason for the test is screening, then screening is always the first listed code.  The patient is asymptomatic which is why the tes is screening therefor no findings were expected or being looked for, however when they are found they are considered incidental, incidental findings are always secondary codes.
whne this occurs you use the V76.51 first, the finding secondary , the appropriate colonoscopy code with the 33 modifier.


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## MCook (Mar 3, 2013)

I agree with Debra.


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## mtreat (Mar 3, 2013)

Since the surgeon removed a polyp, the screening code no longer applies.


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## Bobbig (Mar 3, 2013)

If the intent was for a screening, you would use the V76.51 as your prime dx.


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## mitchellde (Mar 3, 2013)

The screening V code is always primary, the screening G code for the procedure does go away and is replaced with the colonoscopy code for the exact procedure, the PTmodifier (Medicare) or 33 Modifier (commercial) will tell the payer this was intended as a screening but due to abnormality it contains a diagnostic component.


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## mari2663 (Mar 3, 2013)

When billing Medicare you list the V76.51 first, but use the dx for the polyp as the diagnosis on the line.  
Because of the Affordable Care Act Screening's under general insurances aren't subject to deductibles like they used to.

When I billed without the screening dx insurance companies would subject the member to the deductible - so what I would do is bill for the screening as the first dx and the polyp removal as the 2ndary.  I also would bill it like Medicare says to- not actually using the dx on the line.  

It was basically just easier that way because I didn't want to be yelled at by patients because "I didn't bill the insurance right and they said they would pay 100% for a screening"  Trying to explain to a patient it was no longer a screening once the polyp was found can be trying.


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## mitchellde (Mar 3, 2013)

But it was still screening that is the point it never changed from being a screening.  It is just that in the course of the screening the polyp was discovered, it is not was not an investigative procedure, so the polyp is incidental to the procedure being a screening.  
You do link both the V76.51 and the polyp to the procedure line, you just add the modifier (PT or 33), that is the modifier that will tell the provider it was a screening that contains a diagnostic component and is not subjected to copays/deductible.  But you need the link to both dx codes for it to work like it is suppose to.


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## anmariebrigham (Mar 4, 2013)

The V76.51 is still always first, followed by the polyp code. The intent is a screening and that doesn't change if a polyp is found. There is a coding clinic on this scenerio,  First Quarter 2004 pg 11 - 12
Thanks!


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