Wiki Screening vs Surveillance

[god4me]

May I please have clarification on the following scenario:

Surveillance: Personal history of
adenomatous polyps on last
colonoscopy 5 years ago

45380, Colonoscopy, flexible,
proximal to splenic flexure; with
biopsy, single or multiple
Diagnosis Code(s): --- Professional ---
211.3, Benign neoplasm of colon
V12.72, Personal history of colonic
polyps
What is the correct reporting of the prime dx since this is fllw-up and polyp was found on this visit. Thank you so much

 

[MAult142]

You would use V12.72 as the primary dx since this is the indication for the procedure, and 211.3 as the secondary dx. If the insurance is Medicare you would use the PT modifier on the 45380 to indicate the procedure began as preventative and became diagnostic. If it's a commercial payer, then use modifer 33. Hope that helps!

 

[ibtrazy2u]

How can you have a screening if they had polyps 5 years ago? I thought that a history of polyps followed you and then you could no longer have an actual "screening". Any help appreciated. Thanks.

 

[MAult142]

A lot of these words are used interchangeably and it can get pretty confusing. History of polyps does follow you. Once you have history, you get surveillance colonoscopies instead of screening colonoscopies.

A screening would be for a patient who has no personal or family history of polyps or colorectal cancer.

A surveillance colonoscopy would be for a patient who has personal or family history of polyps or colorectal cancer. Sometimes you will see this referred to as a high risk screening.

A diagnostic colonoscopy would be for a patient who is having symptoms.

Both screening and surveillance colonoscopies are considered preventative by doctors and coders. Insurance companies vary. Medicare considers both screening and surveillance colonoscopies to be preventative but a lot of the commerical payers only consider screening colonoscopies to be preventative. They consider surveillance colonoscopies to be diagnostic and put the charges to the pt's deductible.

Another thing to watch for is that insurance will only consider a colonosocopy to be preventative if nothing is done besides looking and leaving. If a polyp is removed or a biopsy taken,etc, the procedure has now become diagnostic and will go to the pt's deductible unless you add modifiers. That's why you always want to include either the PT or the 33 modifer when the indication for the procedure was screening/surveillance and a polyp was found. And with commercial payers, there isn't a designated G code for screening/surveillance procedures so even if a polyp isn't removed and you're billing 45378 with your V code, go ahead and add the 33 modifier to indicate that this 45378 is preventative.

I hope that's a little clearer than mud.