Has anyone found a good resource article for the correct diagnosis coding for a patient with personal history of colon polyps and is having another colonoscopy? I believe that you cannot use "V76.51" as the primary diagnosis if it has not been 10 years.
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Wiki personal history of colon polyps
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Pam Warren
True Blue
Yes, you can use a screening code. The personal history code means the polyps no longer exist (they have been removed), and you code that secondarily.
So: G0105 (high risk screening due to the history of polyps)
V76.51
V12.72
CMS Manual 100-4, Chapter 60 discusses Colorectal Cancer Screenings.
So: G0105 (high risk screening due to the history of polyps)
V76.51
V12.72
CMS Manual 100-4, Chapter 60 discusses Colorectal Cancer Screenings.
lola828
New
Lots of different answers
I am wondering if there are different guidelines for different payors. I have a patient that had polyps in 2007, normal colonoscopy in 2010 and normal in 2015. No symptoms. I billed it with a V12.72. Patient is mad because BCBS is applying to deductible and argues it should be a routine screening.
Some sources are saying bill V76.51 first and V12.72 second, but other sources say you cannot bill personal history codes with routine screening codes. HELP??
I am wondering if there are different guidelines for different payors. I have a patient that had polyps in 2007, normal colonoscopy in 2010 and normal in 2015. No symptoms. I billed it with a V12.72. Patient is mad because BCBS is applying to deductible and argues it should be a routine screening.
Some sources are saying bill V76.51 first and V12.72 second, but other sources say you cannot bill personal history codes with routine screening codes. HELP??
navila0508
Contributor
payor specific.
medicare and mdc replacements cover as screening.
but commercials sometimes don't. Hx of polyps is considered medical. patient is "under surveillance." colonoscopy intervals are shorter 3-5 years. Most insurance you can look up their preventative screening guidelines to prove to patients its not considered screening. good luck
medicare and mdc replacements cover as screening.
but commercials sometimes don't. Hx of polyps is considered medical. patient is "under surveillance." colonoscopy intervals are shorter 3-5 years. Most insurance you can look up their preventative screening guidelines to prove to patients its not considered screening. good luck
smaloney
New
Stacy Maloney, CPC
We never use V76.51 with V12.72. Also, we only use V12.72 with TA polyps.
We never use V76.51 with V12.72. Also, we only use V12.72 with TA polyps.
Yes, it is payer specific. United Healthcare, Aetna and Cigna have all made statements in writing stating a patient with V12.72 is no longer eligible for a screening. The theory behind it is those patients are on an increased frequency for surveillance colonoscopies so therefore it is not a screening.
It is the payers' response to the ACA and being told they must pay screening colonoscopies at 100%. They decided to redefine a screening colonoscopy.
For all other payers, excepting Medicare, we use a V76.51 in the primary position.