Wiki Anesthesia for Colonoscopy

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ssmiar19

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The doctor marked patient as a screening, patient had history of polyps. The dxs codes are Z86.010 and K63.5. Should ASA 00811 or 00812 be used since the screening turned diagnositic? This is for commercial insurance UHC would a PT or 33 be used. I thought 33 since it is a commercial insurance? Any guidance would be greatly appreciated.
 
Which
ssmiar19 said:
The doctor marked patient as a screening, patient had history of polyps. The dxs codes are Z86.010 and K63.5. Should ASA 00811 or 00812 be used since the screening turned diagnositic? This is for commercial insurance UHC would a PT or 33 be used. I thought 33 since it is a commercial insurance? Any guidance would be greatly appreciated.
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Which insurance is it?

Aetna, UHC & Cigna
You would code: 00811 Z09, K63.5

Theses payors believe that a history of polyps is not a screening but considered a follow up exam making modifier PT inappropriate. You would not use Z86.010, as this is a history code. The finding of a polyp makes Z86.010 inappropriate to code. Also, Z86.010 cannot be listed first in any scenario.

I hope this is helpful.
 
LisaAlonso23 said:
Which

Which insurance is it?

Aetna, UHC & Cigna
You would code: 00811 Z09, K63.5

Theses payors believe that a history of polyps is not a screening but considered a follow up exam making modifier PT inappropriate. You would not use Z86.010, as this is a history code. The finding of a polyp makes Z86.010 inappropriate to code. Also, Z86.010 cannot be listed first in any scenario.

I hope this is helps.
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Ok. Thank you! The insurance is United Healthcare. Which modifier do they accept in a screening appropriate scenario...the PT or 33 just want to verify for future reference. I thought the 33 since it's a commerical insurance.
 
ssmiar19 said:
Ok. Thank you! The insurance is United Healthcare. Which modifier do they accept in a screening appropriate scenario...the PT or 33 just want to verify for future reference. I thought the 33 since it's a commerical insurance.
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PT modifier is used for UHC when a screening colonoscopy becomes diagnostic.

In the case you're describing, no modifier is necessary. It did not begin as a screening.

33 is not used by most insurance. The only one I'm aware of that still requests 33 is BCBSTX.
 
when I put anesthesia code for general anesthesia on a knee surgery it was marked incorrect
Can anyone tell me when and when not to submit anesthesia code on Practicode questions?
Thank you
 
Does anyone know why answer key said to code cerebral palsy on a case for revision of gastrostomy tube
Child has history of, but what does that have to do with the current visit for granulation of tissue at g tube?
Thank you
 
LisaAlonso23 said:
Which

Which insurance is it?

Aetna, UHC & Cigna
You would code: 00811 Z09, K63.5

Theses payors believe that a history of polyps is not a screening but considered a follow up exam making modifier PT inappropriate. You would not use Z86.010, as this is a history code. The finding of a polyp makes Z86.010 inappropriate to code. Also, Z86.010 cannot be listed first in any scenario.

I hope this is helpful.
Click to expand...
Hello Lisa, That answer clear a lot for me, Thansk!!! How will you code this same case for Anthem?
 
socalwetsuits@gmail.com said:
Does anyone know why answer key said to code cerebral palsy on a case for revision of gastrostomy tube
Child has history of, but what does that have to do with the current visit for granulation of tissue at g tube?
Thank you
Click to expand...
I sent in a similar question. The answer key had hypertension, but the surgery was an amputation of the toe; and nowhere did it mention the HTN except in the INDICATIONS for surgery. "A pleasant female with history of diabetes and hypertension presents..." I coded the diabetes with gangrene, but since the HTN was not mentioned in the surgical note, I did not code it.

The reply was that if the diagnosis is included in the INDICATIONS FOR SURGERY, it is coded. Unfortunately this is just as random as all aspects of Practicode. After that I did code all diagnoses in INDICATIONS, but usually they weren't coded in the answer key. And now when those cases were "migrated" to the new platform, those "extra" codes all count against my accuracy score. :(

I agree with you on the case of the child with CP. But unfortunately there's no way of knowing when Practicode will or will not follow their own advice.

The more I do in Practicode, the more confused I become.
 
luannak said:
I sent in a similar question. The answer key had hypertension, but the surgery was an amputation of the toe; and nowhere did it mention the HTN except in the INDICATIONS for surgery. "A pleasant female with history of diabetes and hypertension presents..." I coded the diabetes with gangrene, but since the HTN was not mentioned in the surgical note, I did not code it.

The reply was that if the diagnosis is included in the INDICATIONS FOR SURGERY, it is coded. Unfortunately this is just as random as all aspects of Practicode. After that I did code all diagnoses in INDICATIONS, but usually they weren't coded in the answer key. And now when those cases were "migrated" to the new platform, those "extra" codes all count against my accuracy score. :(

I agree with you on the case of the child with CP. But unfortunately there's no way of knowing when Practicode will or will not follow their own advice.

The more I do in Practicode, the more confused I become.
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Anesthesia coding is very different than all other coding, as we sometimes need to add a diagnosis to justify the Physical Status score (P1-P6) or certain methods of anesthesia (ie, MAC).

I do believe that Practicode is offered to new coders as a way to stop the CPC-As from complaining about not being able to find employment with that A, in addition to being a money grab for AAPC. It's as far from real world coding as it can be. I've seen nothing but complaints about it.
 
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i have a provider billing anesthesia in a POS 11 for colonoscopies. Does anyone have any guidance on this or seen this before? Thank you in advance for your assistance
 
LisaAlonso23 said:
Which

Which insurance is it?

Aetna, UHC & Cigna
You would code: 00811 Z09, K63.5

Theses payors believe that a history of polyps is not a screening but considered a follow up exam making modifier PT inappropriate. You would not use Z86.010, as this is a history code. The finding of a polyp makes Z86.010 inappropriate to code. Also, Z86.010 cannot be listed first in any scenario.

I hope this is helpful.
Click to expand...
@LisaAlonso23 this is super helpful! My department is dealing with the same issues right now. Where were you able to find this specific information for the different payers? I've scoured the internet for hours and I keep finding contradicting or outdated references! Thank you!
 
HaleyD9 said:
@LisaAlonso23 this is super helpful! My department is dealing with the same issues right now. Where were you able to find this specific information for the different payers? I've scoured the internet for hours and I keep finding contradicting or outdated references! Thank you
Click to expand...
Generally speaking you have to check each payer website individually to see if they offer any guidance in regards to colonoscopy billing and how they want it to be coded. I would start there.
 
HaleyD9 said:
@LisaAlonso23 this is super helpful! My department is dealing with the same issues right now. Where were you able to find this specific information for the different payers? I've scoured the internet for hours and I keep finding contradicting or outdated references! Thank you!
Click to expand...
You need to check each insurance's guidelines regarding coding colonoscopies, and put all that information into a spreadsheet to reference.
 
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