Wiki CPT versus HCPCS code on colonoscopy

[jdoneske]

Colonoscopy scenario:

Out patient colonoscopy. Medicare patient.

Patient here for screening colonoscopy. No personal history. No family history. No symptoms.

At time of procedure, patient found to have diverticula, but no polyps and no other abnormalities were found that resulted in a therapeutic procedure.

Do you code:
V76.51 x 2 – Special screening for malignant neoplasm, colon
562.10 – Diverticulosis of colon (without mention of hemorrhage)

45.23 – 45378 -- Colonoscopy, flexible, proximal to splenic flexure; diagnostic,
with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)

or

45.23 – G0121 -- COLORECTAL CANCER SCREENING; COLONOSCOPY ON
INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK (Special coverage
Instructions apply)

Basically, the question is: “Does the fact that the patient was found to have a positive finding (i.e. diverticulosis) that did not result in a therapeutic procedure make the difference as to which CPT code should be used?”

 

[mitchellde]

Colonoscopy scenario:

Out patient colonoscopy. Medicare patient.

Patient here for screening colonoscopy. No personal history. No family history. No symptoms.

At time of procedure, patient found to have diverticula, but no polyps and no other abnormalities were found that resulted in a therapeutic procedure.

Do you code:
V76.51 x 2 – Special screening for malignant neoplasm, colon
562.10 – Diverticulosis of colon (without mention of hemorrhage)

45.23 – 45378 -- Colonoscopy, flexible, proximal to splenic flexure; diagnostic,
with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)

or

45.23 – G0121 -- COLORECTAL CANCER SCREENING; COLONOSCOPY ON
INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK (Special coverage
Instructions apply)

Basically, the question is: “Does the fact that the patient was found to have a positive finding (i.e. diverticulosis) that did not result in a therapeutic procedure make the difference as to which CPT code should be used?”

It was a screening and screening is what was performed... no other procedure was performed. The findings do not make this a diagnostic study. Code it as screening.

 

[rsboggs]

Our office has recently started billing these correctly after many discussions between our ASC and the hospital. The big insurance companies here, Medical Mutual, Anthem etc. have told us that if the patient comes in for strictly a screening colonoscopy that needs to be the first diagnosis listed in addition to any findings during the procedure. Also, if a biopsy or polypectomy is done on a patient that presented for screening, then the cpt code that is appropriate for the biopsy or polypectomy is listed with the first diagnosis of screening and then the polyp etc.

 

[mdimitrov]

I agree with Mitchellde and RSBoggs...happy coding!

 

[JenReyn99]

Me Too

Just for extra reinforcement, I agree too I've been doing ASC and gastro coding for 3 years, and what the previous coders have said is what I know of, glad to know I'm still on the right page too, it's always good to brush up constantly!