Wiki surveillance colonscopy

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Ksumansky

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Would a surveillance colonoscopy for a history of polyps be coded as a screening or diagnostic? Last colonoscopy was 5 year ago with a polyp found. This procedure in 2012 did not have a polyp found. I coded it as v12.72 45378. Patient is very upset and says that it should of been coded as a screening which would of waived any deductible or copay.

:(Any thoughts would be awesome!
 
This is that slippery slope we all talk about almost daily.

I, personally, would code it as a screening if the documentation states such. Meaning, if the doctor dictated the procedure was a high-risk screening due to history of polyps. Then I would have coded it as: 45378 (pt or 33 modifier) - V76.51, V12.72.

But it depends on the payor and their policy.

Now if your doctor just dictated the indication for the procedure is history of polyps? Then you coded it correctly because it sounds like the doctor is doing the procedure because of polyps not to screen for colon cancer.
 
I agree with Coachlang. The only thing I would add is using the preventative services modifier. For instance, 45378-33/v12.72 for a commercial payer. But as previously pointed out, this varies by payer specific guidelines. Some of our payers will recognize this as a preventative service, but others won't if the patient is "high risk". If your physician gets in the habit of stating "screening colon due to pers hx of polyps", then you always have the option of using v76.51 as the primary dx if you need to.
Hope this helps!
 
I am having the same issues with personal hx of polyps and screening. One of our docs would put 'High risk colon cancer surveillance:personal history of colon cancer', do I use screening code and then personal hx code? I have been used the personal hx first.
Could you please give me a good definition of the mod PT and 33. Is Pt only used for Medicare? and can we use 33 with Medicare too? Kathy
 
Kathy,

That's even more funky. Surveillance for colon cancer when they have a history of it. At least with the polyps there is a difference in diagnosing.

I would look at the timeline and discuss with the doctor about amending the documentation or verify his original documentation. Is the pt GI symptom free? Or is there a reason the doctor suspects there might be a re-occurance? Is this Medicare?

In regards to the modifiers: PT is for Medicare only and 33 is for everyone else but Medicare. You do not use 33 with Medicare.
 
Thanks for the reply back. I am looking at that report right now. It is Medicare and would it be right just to code it as G0105, V12.72. The pt has no symptoms, just personal hx of Polyps. Kathy
 
Wait, history of polyps or history of colon cancer?

Either way, as long as there were no findings you would use G0105. Depending on which history it would either be V10.05 (colon cancer) or V12.72 (polyps).
 
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