General Surgery Coding Alert

Question: A patient presented for a screening colonoscopy. The surgeon found polyps and treated them. Therefore, this patient has a diagnosis of benign colon polyp. The patient also has diverticulosis. Should I put the V code for screening for malignant neoplasm as a third diagnosis? In the past Medicare has kicked the claim out and wont pay if I put the V code on, but that seems a proper code.

Nebraska Subscriber

Answer: If the surgeons documentation states that the patient presented for screening colonoscopy,you need to have the V code (such as V76.51,Screening for colon malignancy) as the first diagnosis even if the surgeon found and treated other problems. Medicare has been pretty clear that if the patient presents for screening you have to bill the screening with the V code, even if the physician finds a problem and treats it.

When the surgeon finds and treats a problem, you can no longer report the G code (G0104-G0106,Colorectal cancer screening) for the screening colonoscopy. You do still need to list the V code as the patients primary diagnosis in box 21 of the CMS-1500 claim form.

Tip: Just because the V code is your primary diagnosis, however, does not mean that you have to link that diagnosis in the first position in box 24e. Medicare expects coders to follow the coding guidelines for diagnosis codes, but the line-by-line links do not have to be in that order.

To avoid denials you should list the polyp diagnosis code (211.3, Benign neoplasm of other parts of the digestive system; colon) in the first position in box 24e to describe the medical necessity for the service.

Alternative: Of course, the definition of a screening colonoscopy is a colonoscopy for a patient that presents without symptoms. If this was really a diagnostic colonoscopy because the patient was having pain or bleeding due to his diverticulosis, that changes the coding and reimbursement entirely.

In that case, you should code a colonoscopy with polypectomy (such as 45384, Colonoscopy, flexible,proximal to splenic flexure; with removal of tumor[s],polyp[s], or other lesion[s] by hot biopsy forceps or bipolar cautery) and attach the diverticulosis (562.10, Diverticulosis of colon [without mention of hemorrhage]) and colon polyp (211.3) diagnoses.