Gastroenterology Coding Alert

Question: A 55 year old patient is diagnosed with iron deficiency anemia. He had a normal colon study 5 years ago. This patient has been referred by an oncology group for a colonoscopy. Is there a provision to use the diagnosis of iron deficiency anemia for a colonoscopy?

Mississippi Subscriber

Answer: Multiple researches show that one of the most common cause of iron deficiency anemia (IDA) is loss of blood from the GI tract. Research suggests that at times IDA may be the initial indication for an asymptomatic colonic and gastric carcinoma. So, the provider needs to screen all adult men and postmenopausal women with iron deficiency anemia for the possibility of a gastrointestinal malignancy, according to the American Academy of Family Physicians (http://www.aafp.org/afp/2013/0115/p98.html)

Given this background, it is logical to use IDA as an indication for a colonoscopy. You may choose a code from the group D50 (Iron deficiency anemias) with a fourth digit (0-9) expansion for specificity of origin of the anemia.

• D50.0 (Iron deficiency anemia secondary to blood loss [chronic])
• D50.1 (Sideropenic dysphagia)
• D50.8 (Other iron deficiency anemias)
• D50.9 (Iron deficiency anemia, unspecified)

Caution: Your payer may not cover this diagnostic colonoscopy service to investigate a new condition of iron deficiency as routine screening.

You should educate your patient about the difference between diagnostic and screening colonoscopy, and the forthcoming EOB which will have deductibles and co-payments. The insurance company may suggest that the reason for the patient’s bill was because the physician used the wrong codes.