Wiki Fam History of Colon Ca - under 50

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sheardmd

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I know this subject seems to be hashed and re-hashed, but I don't see a thread addressing this and I didn't feel that the Cutting Edge article adequately addressed it either. Patients that are under 50 and have a family hx, are you coding 1)V76.51 2)V16.0 or just 1)V16.0. I try to code consistently across all ins (Medicaid, Medicare, Commerical Ins), and both Medicare and Medicaid will not accept either G0105 or G0121 for anyone under 50 regardless of the diagnosis. They also will not accept V76.51 without the G codes, so I have to code those as V16.0 and 45378, so that is how I code all of my fam hx patients under the age of 50. Any advice or recommendations would be greatly appreciated.

Thanks!
 
How do you code your colonoscopies for your patients that are under 50 and seeking a colonoscopy due to family history (1st degree relative) of colon ca? Both ICD-9 and CPT please. Thanks!
 
You're right. The screening vs family hx issue (or vs pers hx polyps) has been hashed and re-hashed and everyone stands firm on their point of view. :)

From my experience, it really depends upon the payer. In a perfect coding world, I would code this as 45378/V16.0 for a commercial payer. But in reality, payer policies and that particular patient's plan may dictate what I have to do. Commercial payers may say the patient cannot have a screening service until age 50, no matter what. Others will say there are no age restrictions for family hx. If that payer tells me that this under age 50 patient's plan allows for a screening colonoscopy d/t their family hx of colon cancer, but I need to submit the claim with v76.51 followed by v16.0, that's what I do. Many will allow a screening service for a family hx with the use of the -33 modifier. Despite whatever official guidelines there are, one payer's system edits may differ from another payer. Maybe your MAC has something on the age thing, but if I have an under age 50 Medicare beneficiary receiving a screening colon d/t fam hx colon cancer, I submit with G0105/V16.0 and have no problems.

Interested to see what others say. :)
 
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