General Surgery Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: The patient undergoes colonoscopy with polypectomy. The polyp is sessile, with dysplasia, and the surgeon is uncertain about the lesion's future biological behavior. A year later, the surgeon wants to recheck the polyp site to make sure the polyp hasn't grown back, but the carrier denies the follow-up colonoscopy because it has a "history of polyps" diagnosis. Should we have used M codes as a diagnosis for the repeat colonoscopy?

Arizona Subscriber
  Answer: V code V12.72 (history of polyps, colon) should not be the principal diagnosis, says Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding and reimbursement specialist in Lenzburg, Ill.
 
The key to selecting the correct ICD-9 code is the dysplasia noted in the polyp sample originally removed, and that the polyp was sessile (which indicates it was not entirely removed). Dorland's Medical Dictionary defines dysplasia in pathology as an "alteration in size, shape and organization of adult cells." A finding of dysplasia, therefore, means the tissue is in transition from benign to malignant, which -- translated into ICD-9 terms -- is a "neoplasm of uncertain behavior." This is reported with  235.2 (neoplasm of uncertain behavior, colon).
 
In such cases, additional investigation is required and diagnostic colonoscopies will likely be performed until the surgeon decides the patient requires a colectomy, Mueller says. These are not screenings, she adds, and should be reimbursed if the documentation accurately describes what the surgeon did and 235.2 is used in place of the V code.
 
M codes, or morphology codes, are used by pathologists to identify the status (malignant, benign, in situ, etc.) of biopsies and other tissue samples. Surgeons should not use these codes.