Wiki Diagnosis coding for colonoscopy

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VickiS

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Would like to know how other Pathology labs are coding screening colonoscopy: Say a patient has a colonoscopy and polyp is removed sent to your lab, what is the proper dx coding? Now 2nd scenario patient has a history of polyps and has a colonoscopy/polyp found....the reason I ask is because I just came from a Pathology coding conference and was told that once a polyp is removed it is diagnostic and you should code 211.3 1st and then V76.51 second for screening...and 211.3 ,V12.72 for 2nd scenario...and this was a very highly regarded individual in Pathology coding.
 
Agree.

Scenario #1
Screening colonoscopy with polyp removed (e.g. 211.3)
We code this:
211.3
V76.51 (and add any other applicable "V" codes)
*except* for Blue Cross which asks us to code like this:
V76.51 (and add any other applicable "V" codes)
211.3

Scenarios #2
Patient with history of polyps, and has no current diagnostic reason for the colonoscopy. This is just a surveillance colonoscopy. Polyp removed (e.g. 211.3)
We code this:
211.3
V12.72
 
Thank you, we had an issue with BCBS patient who has a history of polyps and I coded it 211.3,v12.72 ...pt was upset that insurance did not pay...so the endoscopy center that done the colonoscopy asked that we code it V76.51,211.3,V12.72 ..so what would you do in this case?...I say we don't change the way we code because she has a history of polyps.
 
I disagree with both of you, unfortunately.

I don't know why the coding rules would be different in Pathology (they shouldn't be, actually), so if the patient presents for a screening colonoscopy, that's your primary code,whether or not polyps are found incidentally. You'd code V76.51 first, and then the code for the finding. The reason for the colonoscopy was a screening. You code that primary, always.

A patient with a history of a polyp should not be coded as 211.3 for a follow up colonoscopy. The polyp is gone, why would you code it? Code V67.09 and V12.72 (or some other code) to support risk of history needing follow up.

Don't forget to use the appropriate G codes for Medicare, and the -33 modifier to identify a screening for the commercial payers.
 
I agree with you as far as screening colonoscopy, using V76.51 and then the finding if any and we use PT modifier for BCBS and we don't use G codes for colonoscopy we use pathology/laboratory CPT's...as for the history of polyps there was a polyp found and I would never code something that is not there and I respectively disagree on patient with history, if nothing is found I would code V12.72.
 
Pam Brooks said:
A patient with a history of a polyp should not be coded as 211.3 for a follow up colonoscopy. The polyp is gone, why would you code it? Code V67.09 and V12.72 (or some other code) to support risk of history needing follow up.
Click to expand...

In both scenarios I wrote, a polyp was removed and sent to pathology, thus the need to include the polyp code. I presume we are discussing how to code the pathology report, not the procedure.
 
Pam Brooks said:
I disagree with both of you, unfortunately.

I don't know why the coding rules would be different in Pathology (they shouldn't be, actually), so if the patient presents for a screening colonoscopy, that's your primary code,whether or not polyps are found incidentally. You'd code V76.51 first, and then the code for the finding. The reason for the colonoscopy was a screening. You code that primary, always.
Click to expand...

Pathology coding IS different. The pathological diagnosis is ALWAYS primary.
 
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vslaughter said:
Thank you, we had an issue with BCBS patient who has a history of polyps and I coded it 211.3,v12.72 ...pt was upset that insurance did not pay...so the endoscopy center that done the colonoscopy asked that we code it V76.51,211.3,V12.72 ..so what would you do in this case?...I say we don't change the way we code because she has a history of polyps.
Click to expand...

You were correct in your coding. This is often a point of confusion for patients and the endoscopy center should be explaining this up front to patients. V76.51 and V12.72 are really mutually exclusive.

V76.51, screening colonoscopy, assumes that the patient has no GI symptoms and no history of colon cancer or polyps.
 
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Sure! This gets so confusing, especially when the coding is different for the procedure and for pathology!

We frequently get requisitions from surgical centers that show only screening for the indication but we can see a history of polyps in our pathology records. These always require special care - looking at all of the information we have and requesting further information if needed.
 
bbooks said:
Pathology coding IS different. The pathological diagnosis is ALWAYS primary.
Click to expand...

Can you point me to the regulatory guidance? (not a consultant/coder opinion) I'd appreciate it.

According to ICD-9 coding guidelines, you always code primarily the reason for the examination, first. I'm assuming that until your pathologist has examined the polyp tissue, this remains a preventive exam. Findings are coded secondarily. I'm referencing AMA's Coding Clinic, 1Q1990, which is a similar scenario.

That's why I'd like to see where CMS or AMA states otherwise, because I'm not aware of any differentiation for pathologists, and I'd love clarification. Thanks for your help.
 
I had a case just today that raised further questions. This patient had on the requisition "colonoscopy screening, last scope 10 years ago," and the pathology was for a tubular adenoma. Our path records showed that the patient had a small hyperplastic (not adenomatous) polyp removed 10 years ago. The insurance provider indicates in their guidelines that surveillance colonoscopies are for a history of adenomatous polyps, and that screening colonoscopies are for persons of average risk.

So, despite what I said earlier about V12.72 and V76.51 being mutually exclusive, perhaps they aren't if V12.72 is in reference to a hyperplastic polyp rather than an adenomatous polyp.

In this case, because of the patient's insurance guideline, I coded this as 211.3, V76.51, V12.72.

I also remembered this article, and I plan to spend some more time with it: http://news.aapc.com/index.php/2013/03/colonoscopy-screening-or-surveillance/
 
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Pam,

Pathologists do not see patients. Ever.
The specimen is coming to us for a diagnosis; that makes what Pathologists do diagnostic services. If some abnormality is found, Pathology MUST list that as the primary diagnosis.
 
Pam Brooks said:
Can you point me to the regulatory guidance? (not a consultant/coder opinion) I'd appreciate it.

According to ICD-9 coding guidelines, you always code primarily the reason for the examination, first. I'm assuming that until your pathologist has examined the polyp tissue, this remains a preventive exam. Findings are coded secondarily. I'm referencing AMA's Coding Clinic, 1Q1990, which is a similar scenario.

That's why I'd like to see where CMS or AMA states otherwise, because I'm not aware of any differentiation for pathologists, and I'd love clarification. Thanks for your help.
Click to expand...

In Padget's Pathology Service Coding Handbook, he references rules O, L, and H as explanations for coding the pathological diagnosis first when coding for pathologists.
 
Every company I have worked for has always debated about this. You can find many articles that contradict each other. We decide to side with Dennis Padget on the issue, but it would be nice to have clear guidelines.
 
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