Gastroenterology Coding Alert

Heads up: Check with insurer for a complete listYour lower gastrointestinal endoscopy claims will stand a greater chance of acceptance if you include the appropriate ICD-9 code to prove medical necessity.Last month, you learned how to zoom in on the right lower endoscopy code in the article "Verify 5 Facts Before Submitting Lower Endoscopy Claims," but your ICD-9 coding is equally important.Why: "Diagnosis codes can really make a difference in getting a claimed processed correctly," says Lora M. Crawford, CPC, billing manager for Southwest Endoscopy & Surgicenter in Gilbert, Ariz.
Examine These Common CodesMedicare carriers publish their own lists of medical-necessity codes for GI procedures on their Web sites. Insurers consider many symptoms justification for a lower GI endoscopy. Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis., offers this list of often-used ICD-9 codes that insurers commonly accept for lower GI endoscopy claims:• 280.0 -- Iron deficiency anemias; secondary to blood loss (chronic)• 280.9 -- Iron deficiency anemia, unspecified • 285.9 -- Anemia, unspecified• 555.0 -- Regional enteritis; small intestine• 562.10 -- Diverticulosis of colon (without mention of hemorrhage)• 562.11 -- Diverticulitis of colon (without mention of  hemorrhage)• 562.12 -- Diverticulosis of colon with hemorrhage• 562.13 -- Diverticulitis of colon with hemorrhage• 787.91 -- Diarrhea• 787.99 -- Other symptoms involving digestive system; change in bowel habits• V10.05 -- Personal history of malignant neoplasm; gastrointestinal tract; large intestine• V12.72 -- Personal history of certain other diseases; diseases of digestive system; colonic polyps• V16.0 -- Family history of malignant neoplasm; gastrointestinal tract• V18.51 -- Family history of colonic polyps.Which code you choose will depend on your gastroenterologist's documentation. Remember: "If a diagnosis does not exist, you cannot just make one up to get the claim paid," Crawford says.Example: The gastroenterologist performs a proctosigmoidoscopy on a patient with documented persistent diarrhea and bleeding. During the procedure, he has to control bleeding via heater probe.
On the claim, you should report:• 45317 (Proctosigmoidoscopy, rigid; with control of bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) for the proctosigmoidoscopy.• 787.91 to 45317 to account for the diarrhea. Note: While the listed ICD-9 codes commonly prove medical necessity on lower GI endoscopy claims, you should check with your individual carrier before using these or any other diagnosis codes on a claim.