Gastroenterology Coding Alert

Warning: Leaving off the V code for high-risk patients could cost you If you think V codes aren't vital to your claims for colorectal cancer screening services, prepare to face denials due to lack of necessity. 

Why? The coder must assign the most precise diagnosis codes to reflect the physician's narrative description of the symptom or diagnosis, experts say. In many cases, that precision requires V codes because they often identify reasons for medical encounters for other than disease or injury. Don't miss an opportunity: "I really believe reporting V codes is underutilized, especially in the outpatient setting," says Mary Mulholland, BSN, RN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia.
Gain Reimbursement Victory With Help of V Codes Let's face it: In addition to reflecting utilization patterns and appropriateness of healthcare costs, V codes do impact payment for some gastro services. In other words, if you don't use them, you won't get paid. 
Finding the right V code for colorectal screening procedures takes only a little more effort for the coder -- and goes a long way toward keeping your office in compliance with insurers. Note: You should check the Medicare Web site for the complete list of acceptable V codes for high-risk patients.
High-Risk Screenings Should Always Have V Code For a high-risk patient older than 50, Medicare will pay for a colorectal cancer screening once every two years. But to identify a patient as high-risk, you must include a V code on the claim.

Coding truth: If the gastroenterologist performs a colorectal cancer screening on a 50-year-old high-risk Medicare patient, experts recommend: reporting G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) for the high-risk cancer screening. linking the appropriate V code to G0105. Some V codes that prove medical necessity for G0105 are V10.05 (Personal history of malignant neoplasm; large intestine), V10.06 (... rectum, rectosigmoid junction, and anus) and V16.0 (Family history of malignant neoplasm; gastrointestinal tract). Coding consequences: If you don't report the V code for personal or family history, Medicare will deny the G0105 claim. Include a V code on every colorectal cancer screening for high-risk Medicare patients.
V Codes Are a Must for Prescreening E/Ms You should also use V codes when the gastroenterologist provides a pre-colonoscopy screening for an asymptomatic Medicare patient. Gastroenterologists commonly perform this screening before an average-risk colorectal cancer screening (G0121, Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).

Example: A new Medicare patient calls and wants a colorectal cancer screening. The patient is not high-risk, but before scheduling the colonoscopy the gastroenterologist still examines the patient for risk factors that may endanger him during the [...]