When Is a Screening Not a Screening? The Answer May Surprise You

Cover all your bases before siding with V76.51 as a primary dx.
If you’re confused as to whether you should still report a V code as a primary diagnosis if the physician finds a polyp or other neoplasm during a screening colonoscopy, you’re not alone. On this topic, even the experts don’t agree.
So, what should you do? Consult your top payers, take a position and be consistent.

CMS Says Put the Diagnostic Code First …

Back in February 2006, William Rogers, MD, head of CMS’ Physician Regulatory Issues Team, publicly stated, "the [CMS] policy is that if you find a polyp and remove it, you change to the diagnostic code" when reporting a primary diagnosis for the procedure.
Therefore, for instance, you would report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk) for an average-risk patient receiving a screening colonoscopy or G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) for a high-risk patient. If the physician discovers a polyp during the screening, however, you should switch to an appropriate diagnostic colonoscopy code (such as 45380, Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple).
Additionally, when the physician visualizes and biopsies the polyp, you should change the primary diagnosis from the V code (such as V76.51, Special screening for malignant neoplasms; colon) to an appropriate polyp diagnosis (for instance, 211.3, Benign neoplasm of other parts of digestive system; colon). You may still use the V code -- albeit secondary to the polyp diagnosis -- to indicate that the colonoscopy began as a screening.
Rogers’ advice was consistent with the AMA position as articulated in the January 2004 CPT Assistant, notes Chris Felthauser, medical coding instructor for Orion Medical Services in Eugene, Ore.
AMA instructions state, "If a therapeutic procedure is performed, then the appropriate CPT code(s) are reported with the ICD-9-CM diagnosis code that reflects the finding that required the therapeutic procedure. The diagnosis code reflecting the indication [that is, the screening] should be listed secondarily." In other words, you should put the polyp diagnosis first when the physician finds a polyp and performs a therapeutic procedure.
… but ICD-9 Says V Code Remains Primary

In direct opposition to the CMS and AMA positions, the official ICD-9 "Coding Guidelines," stipulate, "A screening code may be a first listed code if the reason for the visit is specifically the screening exam… Should a condition be discovered during the screening then the code for the condition may be assigned as an additional [note: not the primary] diagnosis" [emphasis added].
The AHA Coding Clinic [...]

- Published on 2008-11-27