# Screening Colonoscopy versus Surveillance Colonoscopy



## wsoler

I have a few questions regarding this issue. If anyone can offer _any_ assistance in this matter it would be greatly appreciated:

1. What is the difference between screening and surveillance colonoscopy?

2. A pt. comes in for colonoscopy who has a history of colon polyps, during the exam a polyp is found and removed. What is the principle diagnosis?

3. A pt. comes in for a colonoscopy who has a history of colon polyps, the pt. has a normal exam with no findings. What is the principle diagnosis?


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## scorrado

The principal dx for 2 and 3 would be v1272 - personal hx of colon polyps. Screening is someone who has no symptoms,  personal history, or family hx.  Surveillance would be for someone who has a hx (polyps, cancer) or family hx.  Hope this helps!


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## wsoler

It is my understanding that V12.72 is an unacceptable principle dx and can only be used as a secondary dx. The ongoing discussion between coders at our facility is that the principle dx should be 211.3, while others say it should be V76.51.


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## RebeccaWoodward*

• Indicate the Primary Diagnosis using the International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) code for the screening examination (colonoscopy or sigmoidoscopy), and
• Indicate the Secondary Diagnosis using the ICD-9-CM code for the abnormal finding (polyp, etc.).
*• For example, V76.51 (Special screening for malignant neoplasms, Colon) would be used as the first listed code, while the secondary code might be 211.3 (Benign neoplasm of other parts of digestive system, Colon).*

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0746.pdf

Does this help?


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## wsoler

It does, however, it is my understanding if they have a history of polyp, then it is no longer a screening, but now a surveillance and therefore you cannot use the V76.51... Please excuse my confusion, it's just that we've got some very skilled coders that have been coding these scenarios very differently and have gone through numerous audits and none have been flagged, is it possible that either way is ok?


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## elenax

I agree with Rebecca, the guidelines indicates that the screeening dx should be coded first, also if the doctor documents that is a screening colonoscopy even though the patient has a hx of colon polyps, I document both the screening and the history dx.


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## Lisa Bledsoe

I agree with NELENAZ.  I use both V76.51 and V12.72.  If a polyp is found and poylpectomy performed, use 211.3 as the third code on the claim, but as the first code on the line item.  Your claim would look something like this:
dx 1=V76.51   dx 2=V12.72   dx 3=211.3
line item:  45385  dx 3,1,2
Lisa


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## scorrado

This goes back to a point that I have brought up several times - as a coder we are to code to the highest specificity. So, a patient with a history of colon polyps would not be coded as V7651 - they would be V1272. Screening is not specific enough.


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## wsoler

Thank you ALL soooo much for all of your feedback!!!! You've been very helpful!! Have a great day


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## aguelfi

*Survelliance EGD/ Colonoscopy*

Pre-op dx is "Family hx of stomach and colon cancer, for surveilliance of colonoscopy and upper endoscopy."

Post-Op dx: is "Gastritis, small hiatal hernia,internal hemorrhoids, polyp in the proximal ascending colon.

What are the diagnosis I would use?
I used 211.3 for the colonoscopy and 535.40 for the EGD but what about 
V16.0, would I use it and would it be primary or secondary?


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## rcclary

What if the patient comes in w/ a routine screening V76.51 and the colonoscopy reveals Diverticulosis 562.10.  Which code would come first?


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## mad_one80

rcclary said:


> What if the patient comes in w/ a routine screening V76.51 and the colonoscopy reveals Diverticulosis 562.10.  Which code would come first?



you would list the dx on the claims as:
1. v76.51
2. 562.10

BUT you would only link the 45378 to dx #2 (for the abnormal findings)

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0746.pdf


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## mad_one80

abenson said:


> Pre-op dx is "Family hx of stomach and colon cancer, for surveilliance of colonoscopy and upper endoscopy."
> 
> Post-Op dx: is "Gastritis, small hiatal hernia,internal hemorrhoids, polyp in the proximal ascending colon.
> 
> What are the diagnosis I would use?
> I used 211.3 for the colonoscopy and 535.40 for the EGD but what about
> V16.0, would I use it and would it be primary or secondary?



for the 45378 you would bill dx:
1. v16.0
2. 211.3
3. 455.0
link the 45378 to #2,3

for the egd 43235/43239(biopsy) you would bill dx:
1. v16.0
2.535.40
3. 553.3
link it #2,3

because the abnormal findings would be the fist linked dx but you still include the family hx dx

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0746.pdf


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## mad_one80

Indicate the Primary Diagnosis using the International Classification of Diseases, Ninth Revision, Clinical Modification, (ICD-9-CM) code for the screening examination (colonoscopy or sigmoidoscopy), and
• Indicate the Secondary Diagnosis using the ICD-9-CM code for the abnormal finding (polyp, etc.).
For example, V76.51 (Special screening for malignant neoplasms, Colon) would be used as the first listed code, while the secondary code might be 211.3 (Benign neoplasm of other parts of digestive system, Colon).
• Item 24D (Procedures, Services, or Supplies)
• Indicate the procedure performed using the CMS Healthcare Common Procedure Coding System/Common Procedure Terminology (HCPCS/CPT) code for the procedure (biopsy or polypectomy), and
• Item 24E (Diagnosis Pointer)
• Enter only "2" (to link the procedure (polypectomy or biopsy) with the abnormal finding (polyp, etc.)

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0746.pdf


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## aguelfi

I've already read the MLN article before I understand.  What I'm trying to fnd out is does the V code actually go on the HCFA at all?  I just don't get this linking thing.  When I put it in my computer, it links it and that's it.


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## Lisa Bledsoe

Yes, if the initial intent was for screening then V76.51 should be on the claim form.


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## JeanFerguson

*screening colonoscopy with a history of colon polyp*

It is my understanding that ICD-9 Code V67.59 followed by V12.72 is most correct since it is a follow-up screening. The patient has already had an initial screening colonoscopy and polyps were found.


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## JenReyn99

So I have something to say on this too...shocker! I agree with SCorrado, we need to code to the highest level of specificity that we can. This year marks my 5th year doing gastro coding, and I can honestly say that I have made some big changes in the way I do coding this year. I haven't had any payer problems because I think that when you do code to highest specificity, it is the most accurate reflection of what is going on. I think that you CAN code with a V76.51 and then the V12.72, but I don't think that is THE MOST correct way of doing things. If you want to be coding as close as you can to how it is supposed to be, you might want to review the section of the ICD-9 Book where it talks about screenings, there is a really good section on that subject in there. I can tell you that I feel much more confident that I am doing it the correct way since I started using speceficity as my guide. :0) I used to use the V76.51 a lot, and now, I use V12.72 and V16.0 a lot more. Not only do these codes more accurately reflect why the patient came in, but they also benefit the pt. as far as payer reimbursement goes, because even if they find something and a therapeutic procedure is done, the payers will still not apply to deductible for most pt's if they CAME IN for the purpose of a screening, or a follow-up on previous polyps. I have found this to be extremely effective. So here's an example:

Polyp found, removed by snare in a pt. that came in because of a history of colon polyps:
45385 - V12.72, 211.3...simple as that! and they WILL pay! I promise, I've billed like this for quite awhile, and haven't had ANY problems, I have very few patient calls, and I think it's the most accurate reflection of what happening. 


Look at me ramble on.. I'm done now..hope this is helpful, and not confusing!


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## jlaird

Thank you that was very helpful


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## bmanene

*colonoscopy*



wsoler said:


> It is my understanding that V12.72 is an unacceptable principle dx and can only be used as a secondary dx. The ongoing discussion between coders at our facility is that the principle dx should be 211.3, while others say it should be V76.51.



V12.72 for surveillance due to previous polyps or cancer. V76.51 initial screening to pt . Code 211.3 cannot be principal dx because the patient is going through procedure. If polyps or cancer is found then the latter applies as a secondary dx.


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## tlsonnier

I am also confused.  My physicians did a screening colonoscopy on a patient and found polyps in 2007, 10 years ago. We coded it 45380PT , V76.51, 211.3. Pt came back 3 years later, 2010, for screening/surveillance and nothing was found, G0121, v12.72. Patient had another colon 3 years after the last one ,2013, and nothing found again, G0121,v12.72. Pt is now coming back in for screening colon. My question is, the pt had a screening 10 years ago and has personal history of polyps but nothing has been found for 10 years, can we bill a true screening, G0105, Z12.11 or do we still need to use the personal history code Z86.010? Will copay and deductibles apply?


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