Update: Watch How You Sequence and Link Colonoscopy Dx

Don’t be thrown by this wrinkle in ‘screening-turned-diagnostic’ coding
Recent CMS instruction has ended confusion over how to diagnose a screening colonoscopy that turns diagnostic with polyp removal, but there remains one potential pitfall when you’re preparing these claims. Get the complete facts here to avoid a crucial mistake.

List Screening V Code First …

If a service for a Medicare beneficiary starts out as a screening examination, "then the primary diagnosis should be indicated on the form CMS-1500 (or its electronic equivalent) using the ICD-9 code for the screening examination," says Medicare Learning Network (MLN) Matters article SE0746, "Coding for Polypectomy Performed During Screening Colonoscopy or Flexible Sigmoidoscopy."
Cite neoplasm as secondary: MLN Matters SE0746 further instructs that if the physician finds a neoplasm during a screening exam, you should "indicate the secondary diagnosis using the ICD-9-CM code for the abnormal finding (polyp, etc.)."
Example: During a previously scheduled screening colonoscopy for a Medicare patient, the physician discovers several polyps, which he removes immediately by snare technique (for instance, 45385, Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s] or other lesion[s] by snare technique: APC 0143).
In this case, because the service began as a screening, you would assign the screening V code as the primary (first-listed) diagnosis (for instance, V76.51, Special screening for malignant neoplasms; intestine; colon). You would then list an appropriate ICD-9 code on the second line to describe the neoplasms the physician removed (for example, 211.3, Benign neoplasm of other parts of digestive system; colon).

… but Link the Polyp Dx to CPT Code

Although you should list the screening diagnosis first on the claim form, your diagnosis pointer should nevertheless link the appropriate polyp diagnosis to the diagnostic colonoscopy CPT code, says Diane O’Brien, a nearly 40-year veteran insurance coder and coordinator with Surgical Associates in Warner Robins, Ga.
CMS explicitly requires this coding. In an example of a screening-turned-diagnostic colonoscopy, MLN Matters SE0746 instructs you to enter a "2" in the diagnosis pointer (Item 24E on the CMS-1500 claim form), thus linking the CPT procedure code to the "line 2" diagnosis (that is, the polyp). Further language in the article clearly indicates that the "2" in Item 24E is "to link the procedure (polypectomy or biopsy) with the abnormal findings (polyp, etc.)."
Therefore, for our example above of a diagnostic colonoscopy (45385) that began as a screening, with a primary diagnosis of V76.51 and a secondary diagnosis of 211.3, you would enter V76.51 in box 21 (1) of the CMS-1500 claim form. In 21 (2), you would list 211.3. In [...]

- Published on 2008-05-09