# Screening Colonoscopy w/HX of Chronic Constipation



## coderguy1939 (Aug 11, 2008)

I've been reading the posts on Screening Colonoscopies and from what I'm able to gather a Medicare patient with a long history of constipation who has come in for a screening colonoscopy would have to be coded with 45378 and 564.00 rather than a G code and 
V76.51.  I'm having trouble understanding why a history of constipation would preclude using the screening codes.  Can anyone direct me to guidelines that would clarify this particular situation?  Thanks.


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## Lisa Bledsoe (Aug 11, 2008)

I don't think Medicare covers 45378 for constipation...at least it is not on the TrailBlazer's LCD.  I would code G0121/V76.51.


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## coderguy1939 (Aug 11, 2008)

I agree with you and have always coded that way in the past.  However, please see the 06/25/08 post titled "ICD squence for screening colonscopy" where the advise was never use V76.51 if the patient has symptoms, personal or family history.


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## mbort (Aug 11, 2008)

depending on the documentation you may be able to use "change in bowel habits" 787.99


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## coderguy1939 (Aug 11, 2008)

Long history of constipation would seem to preclude using change in bowel habits.  What I'm trying to clarify if why that preoperative DX would not allow coding a screening colonoscopy which is what is being said in the 06/28/08 posting I referred to in my last response.  The coder is saying any symptoms, personal or family history of a GE nature would not allow you to code a screening colonoscopy, which does not make sense to me.  Family history seems to be a perfect reason for doing a screening.


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## Lisa Bledsoe (Aug 11, 2008)

I copied and pasted the response I think you are referring to here:

_"I do not feel it is appropriate and never use V7651 if the patient has a personal history or family history. We have insurances that do the same thing but it is important to use the history dx so the patient is justified in having their colo's sooner then somone who does not have a history. This same thing was addressed in a seminar I went to in March and the speaker stated that screening should only be used if there is no signs, symptoms, personal or family history. Hope this helps!"_

I disagree with this statement in part.  I believe it is absolutely appropriate to code screening prior to "hx of" codes.  History of is not a sign/symptom.  You are screening to determine if; 1) the patient's family hx is currently an issue; or 2) if the patient's past history is currently an issue.  Does that make sense?


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## coderguy1939 (Aug 11, 2008)

It makes perfect sense.  Let me ask another question.  If what the doctor meant by HX of chronic constipation is that the patient is chronically constipated, would a DX of 564.00 not allow the use of 
V76.51 if the reason for the procedure is screening?


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## Lisa Bledsoe (Aug 11, 2008)

coderguy1939 said:


> It makes perfect sense.  Let me ask another question.  If what the doctor meant by HX of chronic constipation is that the patient is chronically constipated, would a DX of 564.00 not allow the use of
> V76.51 if the reason for the procedure is screening?



I don't see why you could not use V76.51. If the patient is chronically constiapted, isn't that more of a "normal" state for the patient?  To me, screening would still be appropriate.


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## coderguy1939 (Aug 11, 2008)

I agree and so I think that any and/or all pre-existing GE conditions should not necessarily exclude coding a screening colonoscopy.  Thank you for all of your input.


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## Treetoad (Aug 11, 2008)

I agree with Lisa.  Just because the patient is chronically constipated, doesn't mean the provider isn't doing a screening colonoscopy.  I think that if I were coding this procedure, I'd be inclined to code as screening with the additional diagnosis of constipation.


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## mkj2486 (Aug 11, 2008)

Well, if the documentation states it is a screening then you can use V76.51.  If screening is not mentioned then you have to use 564.00.  You cannot decide if this is a screening or not it has to be documented.  Just because the physician is doing a colonoscopy does automatically mean they are screening for cancer.  No, Medicare will not cover constipation, your provider will have to get a signed ABN beforehad in order to do the colonoscopy.  Physician's think that constipation is an important reason to do a colonoscopy.....Medicare does not....the physicians cannot comprehend why they cannot do a colonoscopy on a Medicare patient for constipation. It just is not payable.  If you have no ABN...you have to write it off.


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## Treetoad (Aug 11, 2008)

You're absolutely correct in regards to the documentation supporting the screening colonoscopy.  I thought, by reading the first item in this thread, that we were referring to a screening colonoscopy.


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## scorrado (Aug 12, 2008)

I agree with MKJ. It is how the doctor documented it on the op note. If he documented on the op note that he is doing the colo for chronic constipation that is what needs to be coded. If he says screening - you code screening. If your doctor states both on the op note then symptoms trump screening. Fortunately, constipation is a paid diagnosis for Trailblazer here so we do not have the ABN issue. It is my quote that Lisa copied in her previous reply and I stand by that. The doctors need to be very clear on the op note why they are doing it.  There is no issue with doing a screening on a patient who has chronic constipation. The doctor just cant mention constipation on the op note.


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## coderguy1939 (Aug 13, 2008)

The doctor was clear in the op note that this was a screening colonoscopy and documented in history part of the note that the patient had chronic constipation.  Are you saying that by simply mentioning chronic constipation anywhere in the op note that the colonoscopy becomes diagnostic?  If you have any guidelines that you are using from Medicare regarding this issue, where can I locate them?  Thanks.


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## Treetoad (Aug 13, 2008)

I'd be curious to see that myself.


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## scorrado (Aug 13, 2008)

The information I was given regarding all of this came from a seminar I went to in March that was put on by McVey. Many of us in the seminar brought up the issue of our doctors documenting the reason for the colo on the operative note as "colo for screening in a patient with intermittent rectal bleeding" (or any other problem the patient might be having). She told us that we needed to get with out doctors and they needed to amend the op notes to state either just screening or rectal bleeding. That if they leave both screening and rectal bleeding that you have no choice but to code the rectal bleeding but their true intent may be that they know the rectal bleeding is from hemorrhoids and they are doing the colo for screening purposes. By leaving both as the "reason" it is not very clear what the doctors true reason for doing the colo is. Because of this information I was given at this seminar - I (and many others) have been coding this way every since. I think it makes sense and my doctors have gotten very good about putting either screening as the reason for the colo or a problem the patient is having. I dont have the issue of two reasons anymore on the op note. Makes my life easier!  I am sure if you got in touch with someone at McVey they could send you all the documentation they have on this.


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## coderguy1939 (Aug 14, 2008)

Thanks for all of the information.  I appreciate it.


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