Gastroenterology Coding Alert

Question: The gastroenterologist conducted a colonoscopy to determine whether a patient had Crohn’s disease, and reported 45378 (Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)). Which diagnosis code will allow us to collect for this service?

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Answer: The answer to which diagnosis code applies here depends on the final diagnosis. If the physician definitively diagnosed the patient with Crohn’s disease based on the results of the colonoscopy, you should report K50.90 (Crohn’s disease, unspecified, without complications) as the primary diagnosis for the colonoscopy.

However, if your gastroenterologist performs the service and the evidence is inconclusive, you should fall back on signs and symptoms. Typical signs and symptoms indicative of Crohn’s disease include abdominal pain, diarrhea, fever, loss of appetite, and rectal bleeding.

Most importantly, your question refers to which diagnosis code will allow you to collect for the procedure. Remember that it’s incorrect coding to simply select a diagnosis code based on whether it’s a payable diagnosis for the service you performed. Always base your diagnosis code on the documentation of what the physician confirmed for the patient, rather than what will allow you to collect.