# personal history of colon polyps



## 00043955 (Aug 18, 2015)

Has anyone found a good resource article for the correct diagnosis coding for a patient with personal history of colon polyps and is having another colonoscopy? I believe that you cannot use "V76.51" as the primary diagnosis if it has not been 10 years.


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## Pam Brooks (Aug 18, 2015)

Yes, you can use a screening code.  The personal history code means the polyps no longer exist (they have been removed), and you code that secondarily.   

So: G0105 (high risk screening due to the history of polyps)
V76.51 
V12.72  

CMS Manual 100-4, Chapter 60 discusses Colorectal Cancer Screenings.


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## CVelez (Sep 1, 2015)

According to ICD-9 guidelines you cannot bill personal history codes with screening codes.


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## lola828 (Sep 10, 2015)

*Lots of different answers*

I am wondering if there are different guidelines for different payors.  I have a patient that had polyps in 2007, normal colonoscopy in 2010 and normal in 2015.  No symptoms.  I billed it with a V12.72.  Patient is mad because BCBS is applying to deductible and argues it should be a routine screening.  
Some sources are saying bill V76.51 first and V12.72 second, but other sources say you cannot bill personal history codes with routine screening codes.  HELP??


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## navila0508 (Sep 16, 2015)

payor specific.

medicare and mdc replacements cover as screening. 
but commercials sometimes don't. Hx of polyps is considered medical. patient is "under surveillance." colonoscopy intervals are shorter 3-5 years. Most insurance you can look up their preventative screening guidelines to prove to patients its not considered screening. good luck


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## smaloney (Sep 26, 2015)

*Stacy Maloney, CPC*

We never use V76.51 with V12.72. Also, we only use V12.72 with TA polyps.


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## pamsbill (Sep 27, 2015)

lola828 said:


> I am wondering if there are different guidelines for different payors.  I have a patient that had polyps in 2007, normal colonoscopy in 2010 and normal in 2015.  No symptoms.  I billed it with a V12.72.  Patient is mad because BCBS is applying to deductible and argues it should be a routine screening.
> Some sources are saying bill V76.51 first and V12.72 second, but other sources say you cannot bill personal history codes with routine screening codes.  HELP??



Yes, it is payer specific. United Healthcare, Aetna and Cigna have all made statements in writing stating a patient with V12.72 is no longer eligible for a screening. The theory behind it is those patients are on an increased frequency for surveillance colonoscopies so therefore it is not a screening. 

It is the payers' response to the ACA and being told they must pay screening colonoscopies at 100%. They decided to redefine a screening colonoscopy.

For all other payers, excepting Medicare, we use a V76.51 in the primary position.


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## TAMCAMP (Oct 6, 2015)

if it is a medicare patient you bill v12.72 as primary dx code along with G0105 for high risk colon screen


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## chewri (Oct 8, 2015)

Excellus in NY state sent out a letter July 11, 2014 that they will be paying for Hx of colo as a screening and you do bill V76.51 1st and HX 2nd.


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