General Surgery Coding Alert

Don't be thrown by this wrinkle in -screening-turned-diagnostic- coding Recent CMS instruction has ended confusion over how to diagnose a screening colonoscopy that turns into a colonoscopy with polyp removal, but there remains one potential pitfall for coders preparing these claims. Get the complete facts here to avoid a crucial mistake. List Screening V Code First - If a service to a Medicare beneficiary starts out as a screening examination, "then the primary diagnosis should be indicated on the form CMS-1500 (or its electronic equivalent) using the ICD-9 code for the screening examination," dictates Medicare Learning Network (MLN) Matters article SE0746, "Coding for Polypectomy Performed During Screening Colonoscopy or Flexible Sigmoidoscopy." Cite neoplasm as secondary: MLN Matters SE0746 further instructs that if the physician finds a neoplasm during a screening exam, you should "indicate the secondary diagnosis using the ICD-9-CM code for the abnormal finding (polyp, etc.)." Example: During a previously scheduled screening colonoscopy for a Medicare patient, the physician discovers several polyps, which he removes immediately by snare technique (e.g., 45385, Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s] or other lesion[s], by snare technique). In this case, because the service began as a screening, you would assign the screening V code (for instance, V76.51, Special screening for malignant neoplasms; intestine; colon) as the primary (first-listed) diagnosis. You would then list an appropriate ICD-9 code to describe the neoplasms the physician removed (for example, 211.3, Benign neoplasm of other parts of digestive system; colon) on the second line. - But Link the Polyp Dx to CPT Code Although you should list the screening diagnosis first on your claim form, your diagnosis pointer should nevertheless link the appropriate polyp diagnosis to the diagnostic colonoscopy CPT code, says Diane O-Brien, a nearly 40-year veteran insurance coder and coordinator with Surgical Associates in Warner Robins, Ga. CMS explicitly requires this coding. In an example of a screening-turned-diagnostic colonoscopy, MLN Matters SE0746 instructs coders to enter a "2" in the diagnosis pointer (Item 24E on the CMS-1500 claim form), thus linking the CPT procedure code to the "line 2" diagnosis (that is, the polyp). Further language in the article makes clear that the "2" in Item 24E is "to link the procedure (polypectomy or biopsy) with the abnormal findings (polyp, etc.)." Therefore, for our example above of a diagnostic colonoscopy (45385) that began as a screening, with a primary diagnosis of V76.51 and a secondary diagnosis of 211.3, you would enter V76.51 in box 21 (1) of the CMS-1500 claim form. In 21 (2), you would list 211.3. In item 24.1.d, enter 45385. Finally, place a "2" in box 24.1.E. Look Out for a Potential Problem CMS- convoluted method of [...]