Wiki Colonoscopy Confusion

[Melissa*Ever*Evolving]

Hello,

When patient presents for a (Screening?)/surveillance colonoscopy and has a history of polyps... (V12.72)

How is this treated:

Patient has the Screening Colonoscopy (as high risk?) due to history of polyps.
Patient has colon polyps found during procedure and removed by Snare Technique.
(211.3)

For Medicare AND Commercial cases,
How would you code?

Medicare:
45385 -PT / V12.72, 211.3?

1.) Would the PT apply? Is this considered to begin as a Preventive Service to Therapeutic?

2.) If the patient has polyps, they no longer have a history and it is considered a present condition is that not correct? So history of polyps (V12.72) would no longer apply? Would we report the history still?


Commercial:

45385 -33 / V12.72, 211.3?

1.) Is this considered starting out as a screening? Does surveillance get considered as a separate guideline from preventive services?

2.) Again, would the V12.72 still be reported since this is how it began, or will it no longer be considered "history of" and be represented with the present condition code 211.3...?


Different resources are telling me different things and I am now blurred...
I know I am probably overthinking this!
Anesthesia is my main billing focus and CMS changed things up on us this year. Has me in a whirlwind trying to figure this out.

Thanks for all of your help!
~Melissa, CPC

 

[lace659]

In my opinion, yes you would use the PT or 33 modifiers, depending on payor, since this definitely started out as a screening. As for the diagnosis, I'm apprehensive as well. If nothing was found I'd just code V76.51, V12.72 for the Screening. Which would identify it as a high risk patient with history of polyps (important when Medicare). But with findings of polyps and removing them, I would be inclined to code it 211.3, V12.72. This would tell the story of polyps found in a patient with a history of polyps and the PT or 33 modifier telling the story that this started as a screening.

I've attached a link below to a great Gastroenterology CPT coding update pdf. I hope you find my reply along with this helpful.

http://gi.org/wp-content/uploads/2014/12/395-005PNQ_14-6-CPT_Coding_Updates_FINAL.pdf