Wiki screening colonoscopy CPT code

[TKoehn]

Medicare Patient has an order for an initial screening colonoscopy because they are 50. during the pre op, patient states to the Dr. that she has been having diarrhea and constipation. He does the procedure and finds nothing.

I know the coding will be 1. V76.51 because that was the reason for the procedure initially, BUt would this be a G0121....or would this need to be a 45378 since the patient had diagnostic issues when she came for that colon?

Maybe the V76.51 shouldn't be used as primary since they came with these new sxs? But I am more concerned about the correct CPT.

Thanks

 

[CodingGuru]

Actually, if the patient comes in with other symptoms, then that is the reason for the colonoscopy, and a screening can't be performed. The G code and screening would not be used. It should be billed with the 45378 with the dx's of the symptoms indicated by the provider.

 

[mitchellde]

Actually, if the patient comes in with other symptoms, then that is the reason for the colonoscopy, and a screening can't be performed. The G code and screening would not be used. It should be billed with the 45378 with the dx's of the symptoms indicated by the provider.

I disagree. This was pre scheduled as a screening. What we do not know is the context in which the patient discussed these symptoms. Sometimes it is just an utterance in response to a question of have you ever had any of these symptoms. The patient claimed to be asymptomatic at the time the procedure was scheduled. A prep was administered which consists of yes diarrhea to clean the colon. These discussed symptoms were not the reason the colonoscopy was scheduled or performed. I call this still a screening only.

 

[cas614]

Just for clarification, our doctor did a consult for a patient who is 49, the patient had a colo 5 years ago for family history of colon cancer that colo was normal. but in the consult letter doctor states thank you for sending this kind referral of your patient with chronic diarrhea over the past 3 years, currently having loose stools 3 times a day, etc but at the end said the patient is also due for 5 year screening for family hx of colon cancer. I told the doctor current colo is for diarrhea since that is the chief complaint on the note, but now the doctor is fighting with me saying this is screening since the patient is due for screening. in order to get this approved because of the patient's age, I will have to back it up with chart notes. Who is right?

 

[mitchellde]

This is a completely different case than the original post. In your case the patient presented with a symptomatic problem and that problem was the reason for the referral. Now if the provider feels he needs the procedure to help to further diagnose the patient, then it is a diagnostic. If on the other he resolves the current symptoms and says oh by the way you are due for a screening and the patient agrees then it is a screening. For this one it will very much depend on how the note was written.

 

[cas614]

Thank you so much for your reply, the whole consultation is all about the diarrhea, then Assessment- dx diarrhea and family hx colo cancer, then for the plan colo-family hx. colo cancer and also a side note saying it is okay to use imodium, doctor does not really specify they are doing colo for diarrhea, but for fam hx...so i guess the doctor is right? Just want to make sure before I tell them go ahead and do this procedure and it will all be covered for screening and then the insurance gets the notes and says no, this is actually not a screening.

Thank you in advance.