Wiki MCR Screening Guideline

[lisner1204]

My physician and I are interpreting a Medicare guideline differently and I would like to know your thoughts.

We have a patient that had a polyp removed 11 years ago. He did not follow-up for another colonoscopy during that time. I coded this as a screening colonoscopy and my physician says it should be a surveillance that once they have had a polyp it is always a surveillance.

I showed him the MLN documentation stating that a screening is ok every 10 years and a surveillance is good every two years if a polyp was found.

What are your thoughts?

Thanks.

Lori Isner, CMA, CPC

 

[cynthiabrown]

For a medicare patient the code would be g0105 which is described as high risk screening. I have in my book dx applicable are v10.05,v12.72,v16.0,v18.5x,555.0..........so i use v76.51 as first listed per definition of the code. If this were a commercial insurance i would not use v76.51. There seems to be conflicting info all the time. Let me know if you find any other guidelines. Today my dr turned in a screening colonoscopy on a patient about to have gbp. She was in her 30's! But had family history so i went ahead and coded as screening

 

[caseef]

Your physician is correct once a polyp is removed then the pt is considered a high risk pt and all further colonoscopies are considered surveillance and not screening.

 

[Angeleke]

I agree that the physician is correct. The first listed should be hx of colon polyps