Wiki Diverticulosis and colonoscopies

[SUEV]

Can a physician bill for a screening colonoscopy for colorectal cancer (V76.51) if the patient has known diverticulosis? The patient's diverticulosis is noted on the H&P but the patient is being seen for a screening. On the indications for his op report the provider lists "screening" and he documents the colonoscopy. There may or may not be polyps removed and the diverticulosis is noted. There's some debate as to whether or not this can still be called a screening. Since the patient is not having signs or symptoms of what's being screened (cancer), should it still be considered screening? On the other hand, we don't have signs or symptoms but we do have a known disease before the colonoscopy. Does this make it diagnostic even if the intent by the physician was a screening? Any thoughts and references would be appreciated!
Thanks,
Sue

 

[JenReyn99]

In my experience, it doesn't matter if the patient has a prior gastro condition, they could have any # of conditions, but that doesn't override the need to have the colon cancer screening. If the doc says that it is a screening, then it should be coded as such. The patient's intent for coming in was that of a screening, and this is what the guidelines state makes it codeable as a screening. The findings are incidental, and if a polyp is removed, you can still code the screening dx V76.51 as the prime dx for most payers.

 

[sleepycats]

Can a physician bill for a screening colonoscopy for colorectal cancer (V76.51) if the patient has known diverticulosis? The patient's diverticulosis is noted on the H&P but the patient is being seen for a screening. On the indications for his op report the provider lists "screening" and he documents the colonoscopy. There may or may not be polyps removed and the diverticulosis is noted. There's some debate as to whether or not this can still be called a screening. Since the patient is not having signs or symptoms of what's being screened (cancer), should it still be considered screening? On the other hand, we don't have signs or symptoms but we do have a known disease before the colonoscopy. Does this make it diagnostic even if the intent by the physician was a screening? Any thoughts and references would be appreciated!
Thanks,
Sue

I would code it as a screening as long as the patient wasn't presenting with signs and symptoms related to the diverticulosis. I wouldn't, however, code it a screening just because the MD states so. For example: screening, rectal bleedand diarrhea listed as pre op Dxs.

 

[SUEV]

Great points

There have been times when a provider has said "screening, extent of ulcerative colitis" and I had to explain that it was diagnostic due to the fact that he's investigating the UC. For those cases in which the patient comes in for a screening with a known condition but is asymptomatic, your responses have been very helpful.
Thanks!