Wiki Clarification needed

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j-fowler57

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I feel like I am beating a dead horse but can someone PLEASE clarify the sequence of codes for a screening colonoscopy with a polyp? Don't need CPT or mod.

Admitting V76.51
Principle V76.51
Secondary 211.3

OR

Admitting V76.51
Principle 211.3

THANKS!!!!!
 
Admitting? Is this a facililty? Inpatient?

Anyways, the first code listed should be the V76.51 screening code. That is the reason the pt is there, for a screening. Then you can either put the history (personal or family) or the findings second.

I usually put the history last.

So my coding charge would look like this:

45380 V76.51, 211.3, V12.72

I guess in your case the admitting and the principle would be the V76.51.
 
THANK YOU Coach!!!!
It is an outpatient thru a hospital. I have always done it that way but "someone" is telling me that it is incorrect. I told them to check the coding clinics guideline. They are telling me "I" am interpreting it wrong. I got zinged on this by an auditor and don't feel that it was correct for them to do so. I had researched coding clinics etc and felt I was correct but then I'm told no it isn't.
I feel better now :D
THANK YOU!!!!
Janice
 
Can you tell me where I can find the rules for this? Our office always codes the history (personal/family) first, findings treated, screening, incidental findings. Any info would be great!
Thanks
Nancy

coachlang3 said:
Admitting? Is this a facililty? Inpatient?

Anyways, the first code listed should be the V76.51 screening code. That is the reason the pt is there, for a screening. Then you can either put the history (personal or family) or the findings second.

I usually put the history last.

So my coding charge would look like this:

45380 V76.51, 211.3, V12.72

I guess in your case the admitting and the principle would be the V76.51.
Click to expand...
 
It's a coding guideline to begin with. You code the reason that the pt is there first. If the documentation suppotrs the screening you lsit that first because that is why the patient is there.

But, you can look in your ICD9 guidelines for the V codes, in my Ingenix/Optum book it's page 22 under Coding guidelines.

It states "A screening code may be a first listed code if the reason for the visit is specifically the screenign exam." Further down it states " Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.

There is nothing under the History (of) section to say where the history of codes should be put in sequence.

Like I've said previously, if the documentation shows the patient is coming in for a screening because they've had polyps or colon cancer,as long as it's within the guidelines of 5 years for high risk and 10 years for average risk and the patient is currently not being treated for the polyps or cancer, then it's a screening. The only thing the personal history code does is show why it's being done at this time interval.
 
I would caution you to review the patient's specific payer guidelines regarding how they want these submitted. Some MAC's as well as BCBS (and others) have specific sequencing guidelines regarding diagnosis codes for screening colonoscopies dependant upon the findings. Go to your MAC website, BCBS website, as well as other payer websites, and seach their guidelines for these procedures. It is surprising how few actually follow ICD9 guidelines.

Good Luck! :)
 
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