Gastroenterology Coding Alert

Question: What diagnosis codes should I use for patients at high risk for colorectal cancer?


South Carolina Subscriber

Answer: What carriers consider "high risk" criteria for colorectal cancer will vary, but most cover those individuals who have a personal history of colon (V10.05, Personal history of malignant neoplasm; gastrointestinal tract; large intestine) or rectal cancer (V10.06, Personal history of malignant neoplasm; rectum, rectosigmoid junction, and anus).

They also cover individuals with Crohn's disease (555.0-555.9) or ulcerative colitis (556.0-556.9). Some carriers cover patients with a personal history of colon polyps (V12.72, Personal history of certain other diseases; diseases of digestive system; colonic polyps), a family history of colorectal cancer (V16.0, Family history of malignant neoplasm; gastrointestinal tract), or a family history of digestive disorders, such as colonic polyps (V18.51, Family history of certain other specific conditions; digestive disorders; colonic polyps).

Keep in mind: Once the cancer discovered during that procedure is removed and the patient returns for follow-up visits or for a surveillance colonoscopy, you should report V10.05 or V10.06.

Did you know? Colorectal cancer is the second most common cancer. Nearly 150,000 people are diagnosed each year, according to the American Cancer Society. Many carriers cover screening colonoscopies every 24 months for patients who are at an increased risk for developing colorectal cancer.

Clinical and coding expertise for this issue provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the AMA's CPT Advisory Panel; and Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant in Atlanta.