Wiki Screening in patients with Crohn's disease

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Colliemom

Colliemom

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Patients who have Crohn's or Ulcerative colitis are at high risk of developing colon cancer, so many times our physicians are doing the colonoscopy on these patients to screen them for colon cancer.

So our physicians feel these colonoscopies, being done to screen a patient with Crohn's disease for possible colon cancer, would be appropriately coded with V76.51 as the primary dx. My concern is that these patients really do not have "an absence of symptoms."

What are your thoughts? (and if you have any resources to support your opinion, I would appreciate links)
 
It's a sticky situation. Medicare considers both Crohns and UC to be preventative reasons to have a colonoscopy. You can bill those dx codes with the G0105 or if something more is done, you can put the PT modifier on whatever CPT code you end up billing and Medicare will pay preventative benefits. I know that's the case with WPS Medicare. I think it's true across the board, but I could be wrong about that.

No such luck with the commercial insurance plans. Unfortunately, when a patient has a chronic disease, even if they're not having a flare, they still have the disease. And when the provider is scoping them, they are doing so because they have Crohns or UC and are monitoring the progression of the disease. I agree with you that the V76.51 wouldn't be appropriate. Plus if you're coding for a patient under the age of 50, using V76.51 would just get the claim denied since the patient hasn't met the age requirement yet.
 
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