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Terry CPC

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Pt comes in for a 5 year colonoscopy screening. He has a strong family history of colon cancer He had precancerous polyps removed the last time he had his colonoscopy(5 years ago). How would any of you code this. I've been told you would put a post op procedure code. I don't agree, he had them removed 5 years ago. History of polyps yes post op no. Please help

I would code the screening for colon cancer primary, history of colon polyps secondary, and family history of colon cancer 3rd. Do any of you disagree, agree? :confused:
 
Terry,
I have to agree with your choices. Post-op shouldn't even be in the question...it was 5 years ago. In my opinion you are correct with the screening, hist polyp, and FH colon cancer.
 
Colonoscopy with history of Polyps

Hi,

I would try coding:
Admit:V67.09
First Listed Dx (PDX): Depends. If new polyps are found and removed, code 211.3 colon polyps or 211.4 polyps are in rectum. If no findings, V67.09 will pass with V12.72.
Seconday Dx: List any other findings (ex. colon diverticulosis, hemorrhoids).
plus V12.72 (for hx of colon polyps) and V16.0 (if there's family hx of colon malignancy).
Plus the appropriate colonoscopy procedure codes.

Hope this helps.

Maria
 
According to Medicare guidelines, and alot of commercial plans to, your patient is still considered high risk, hence his five year interval. His personal hx of polyps would be first then his family hx.
 
Terry CPC said:
Pt comes in for a 5 year colonoscopy screening. He has a strong family history of colon cancer He had precancerous polyps removed the last time he had his colonoscopy(5 years ago). How would any of you code this. I've been told you would put a post op procedure code. I don't agree, he had them removed 5 years ago. History of polyps yes post op no. Please help

I would code the screening for colon cancer primary, history of colon polyps secondary, and family history of colon cancer 3rd. Do any of you disagree, agree? :confused:
Click to expand...

You are absolutely correct! ;)
 
colonoscopy w/ history of polyps

Terry - you are correct in your coding with the screening code first, then the pt's personal hx of polyps, the fam hx of polyps. For Medicare patients, we do not use the "fam hx of" as they do not like it.

LaSeille Willard, CPC
 
Hmmmmmmmm, I was taught that if there is a history of colon polyps, that is your primary Dx, if nothing is found on the colonoscopy that is. If a polyp, etc. were found that would be primary. The reason for the colonoscopy is the history of polyps. For Medicare you would use G0105 for the screening code if nothing is found. Family history, V16.0 or V19.8, are also valid Dx's for G0105 for medicare. I only use V76.51 if nothing has ever been found, i.e. previous colonoscopies have been normal. Correct me if I am wrong, please.
 
mkj2486 said:
Hmmmmmmmm, I was taught that if there is a history of colon polyps, that is your primary Dx, if nothing is found on the colonoscopy that is. If a polyp, etc. were found that would be primary. The reason for the colonoscopy is the history of polyps. For Medicare you would use G0105 for the screening code if nothing is found. Family history, V16.0 or V19.8, are also valid Dx's for G0105 for medicare. I only use V76.51 if nothing has ever been found, i.e. previous colonoscopies have been normal. Correct me if I am wrong, please.
Click to expand...

I guess the way I look at it is that you are still screening for a malignant neoplasm. So even with the previous history or family history of "polyps", the intent is screening when the procedure begins. I am not saying you are wrong; we all know as coders things can be interpreted differently. I would be careful with G0105 however, and make sure that the patient meets the "high risk" criteria for Medicare.
 
I definitely would not use screening first. If the patient has a history that is the reason they are coming back in five years. Otherwise they would come back in 10 and that would be screening. Medicare states that high risk patients are patients with personal history of cancer or polyps, family history of cancer or polyps, and also Crohn's disease. So, G0105 would be appropriate with V1272 as the primary dx.
 
Terry CPC said:
Pt comes in for a 5 year colonoscopy screening. He has a strong family history of colon cancer He had precancerous polyps removed the last time he had his colonoscopy(5 years ago). How would any of you code this. I've been told you would put a post op procedure code. I don't agree, he had them removed 5 years ago. History of polyps yes post op no. Please help

I would code the screening for colon cancer primary, history of colon polyps secondary, and family history of colon cancer 3rd. Do any of you disagree, agree? :confused:
Click to expand...

I agree with you. This is the correct form of coding.

Thank You
 
colonoscopy w/ hx of polyps

Terry....The patient has a history of polyps....however, you are screening him/her for possible recurrence of the polyps. Since the patient has already had polyps removed, regardless of whether it is 5 years later or 10 years later, you are still screening the patient for recurrence. Your original coding is correct...screening code first, then the pt's personal hx of polyps, then the fam hx of polyps.

LaSeille Willard, CPC
 
For those of you who are coding screening first - aren't we supposed to code to the highest specificity? That is what I was always taught. Then that would mean that the the history of colon polpys would be primary. Also, why would Medicare even have the G0105 code if history of colon polpys should not be used as a primary after 2-5 years? G0105 can only be coded every two years and you only have just a few dx codes you can use and the history codes are on that list but V7651 is not.
 
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I see your point....medicare will deny the G0105 if coded with the V76.51...I would like to see some feedback of this too.:confused:
 
According to Coding Clinic 1st quarter 2004: "Whenever a screening exam. is performed, the screening code is the first-listed code. The fact that the test is a screening examination remains, regardless of the findnings or any procedure that is performed as a result of the findings." So if the physician put screening then I put the screening code V76.51 then the findings if any and then the personal and family history code. But if the physician writes history of polyps then I put V12.72 and then findings and then family history. This is how I would code it.
 
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