Wiki Screening or Diagnostic Colonoscopy

[mdwyer]

Patient came in for a colonoscopy and has a history of colon cancer. The physician's H&P and OR report state this is a screening colonoscopy. When reviewing his chart, he is still under active treatment of colon cancer by oncologist. His diagnosis of cancer occurred 3/19/2010.

Would this be screening or diagnostic? His last "screening" colonoscopy was 4/23/13 and coded as diagnostic. The physician's office is billing this current account as screening, high risk yet the hospital was coding their portion as diagnostic due to active treatment being given by oncology.

Any help or resources for cases like this would be greatly appreciated.

 

[LMCODER]

A screening colonoscopy is for an asymptomatic patient with no history of colon cancer,polyps or gastrointestinal disease.

A surviellance colonoscopy is for a patient with a personal history of colon cancer, polyps or gastrointestinal disease.

If the patient has a history of or current colon cancer it will be a surviellance and not longer a screening.

Per the USPSTF, "When the screening test result in the diagnosis of clinically significant colorectal adenomas or cancer the patient will be followed by a surveillance regiman and the recommendations for screening are no longer applicable."

 

[ssmith955]

Screenng vs Diagnostic Dilemma

I think it is quite clear cut when to use the V76.51 and the 33 ot PT modifier. The problem for us coders arises when the patient has polyps removed and the provider says you need to be rechecked in 3 to 5 years for a surveillance
screening. At this point the patient has a history V12.72. The schedulers schedule for a colon for Hx of polyps V12.72, the coders bill V12.72 as primary with the appropriate modifier and the the findings as the secondary Dx. I have always disagreed with the term "surveillance screening" I feel that if the patient has a hx of polyps v12.72 and the providers is recommending surveillance and the patient has no on going symptoms then this is a screening due to V12.72 and the V76.51 should be used again. However, that is not what we have been told code, that once a V76.51 has been used it can never be used again unless the colon was clean then in 10 years the patient eligible for another V76.51. Insurance companies are not wanted to pay sreening benefits for V12.72 as primary dx even with the correct modifier. Then when patient gets a bill because it has been applied to deductible of course the ins company tells them the provider coded it incorrectly. This is a constant battle between patient, provider and the insurance company. What are your thought and what is the most appropriate way to code when the patient has a V12.72 hx of polyps. All the insurance are different and some consider V12.72 a diagnostic but patients being told it should be V76.51 because pt asymptomatic. Can anyone please share you thoughts and how your office may be handling this.