You Be the Coder: What if You Find Polyps During a Screen?
Question: I read that Medicare has just changed its policy regarding screening vs. diagnostic colonoscopy and that if the physician finds and removes a polyp during a screening, I should still report the screening diagnosis as primary. Is this true?
New York Subscriber
Answer: “The policy is that if you find a polyp and remove it, you change to the diagnostic code,” William Rogers, MD, a physician who heads the Physician Regulatory Issues Team at CMS, said last year. But you can still use the V code diagnosis (secondary to the diagnosis for the polyp) to indicate that the colonoscopy was a screening colonoscopy.
In other words: There’s been no change in policy. If you find a polyp during a screening, the screening automatically becomes diagnostic.
Example: For Medicare patients, you should 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.
But if the physician discovers a polyp during the screening, you should instead report a diagnostic colonoscopy (45380, Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple).
And when the physician visualizes and biopsies the polyp, you should change the primary diagnosis from V76.51 (Special screening for malignant neoplasms; colon) to, for instance, 211.3 (Benign neoplasm of other parts of digestive system; colon).
Another consideration: If the surgeon finds a polyp during a screening, the patient is automatically at high-risk for colon disease and therefore qualifies for more frequent screenings. Also, if the physician feels the need to give the patient another colonoscopy, it will automatically be diagnostic, like a mammogram after a breast tumor.
A final note: If the physician finds a less serious problem, like diverticulosis or hemorrhoids, the screening colonoscopy should remain a screening test. The patient might still qualify as high-risk, however, and receive screening colonoscopies more often.
- Published on 2007-08-24
SuperCoder
