Gastroenterology Coding Alert

Question: When should I use a diagnosis of colorectal cancer versus a diagnosis of history of colon cancer? Should I consider the time elapsed and the patient's physical condition?

Arizona Subscriber

Answer: When a colorectal cancer is present, you would use an ICD-9 code for malignant neoplasm of the large intestine (153.0-153.9 for various sites in the colon, and 154.0-154.8 for various sites in the rectum, rectosigmoid junction, and anus).

Caution: As a general use, you should use this as a diagnosis only for the colonoscopy during which the original lesion is discovered or for a subsequent pre-surgical colonoscopy before the cancer is removed. You can use the same ICD-9 for immediate follow-up visits to discuss treatment options and perform additional workup. If the lesion is unresectable, you can continue to use that diagnosis for follow-up visits.

After the cancer discovered during this procedure is removed and the patient returns for follow-up visits or for a surveillance colonoscopy, you would have to bill V10.05 (personal history of malignant neoplasm, large intestine) or V10.06 (personal history of malignant neoplasm, rectum, rectosigmoid junction, and anus).

Clarification: Medicare and other private insurers would usually deny procedures that have a V code as the diagnosis, but this situation is an exception. Most Medicare carriers and payers list V10.05 and V10.06 as covered diagnoses for diagnostic or therapeutic colonoscopy. Most medical polices will allow surveillance colonoscopies in one year and then every three to five years following resection of the colorectal cancer or neoplastic polyp, and in less than one year if the polyp is large, sessile or has carcinoma in situ.