Oncology & Hematology Coding Alert

Question: The physician gave a patient a colonoscopy. The patient has a family history of colon cancer. The physician used V16.0 (Family history of malignant neoplasm; gastrointestinal tract), but the hospital coded the visit as V76.51 (Special screening for malignant neoplasms; intestine; colon), with V16.0 as the secondary diagnosis. What is the proper way to sequence these codes?

North Carolina Subscriber

Answer: You should sequence the diagnosis codes according to the services the physician performed and the reason for the encounter. In your case, the oncologist probably provided a screening colonoscopy because of the patient's family history of colon cancer.

If you report any of the colorectal cancer screening codes (G0104-G0107, G0120-G0121, and G0328), you should submit V76.51 (Special screening...; colon) for individuals the physician considers a low risk for colon cancer. And you don't need additional ICD-9 codes. But with a high-risk patient, you should use the appropriate high-risk code, such as V16.0 .