Forum - Questions & Answers

Oct 15th, 2010 - mesalamb 26 

history of polyps vs. screening colonoscopy

If a patient has had polyps in the past and presents for another colonoscopy five years later, can that still be coded as a screening colonoscopy with V76.51?

Patients want us to code with V76.51 more often now because they now have waived deductibles for preventative services, but the other billers and I cannot agree on what constitutes screening.

I say if the patient is having no other symptoms, its a screening colonoscopy no matter what happened in the past. The other billers say that if a patient has EVER had polyps, they can no longer have "screening" exams in the future.

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Oct 15th, 2010 - jschmutz   323 

ICD9 Guidelines for Screening Exams

[...if a patient has EVER had polyps, they can no longer have "screening" exams in the future.]

There is nothing that states or supports the above statement. If a disease or condition has been eradicated and no longer exists then a screening diagnosis can be used when appropriate. For example, a patient can have chlamydia more then once. If a patient had it in the past, was treated, and then has reason to suspect a chlamydial infection again then you would use V73.88 for a chlamydial screening.


Per the official ICD-9 Guidelines:

Screening is the testing for disease or disease precursors in seemingly well individuals so that early detection and treatment can be provided for those who test positive for the disease. Screenings that are recommended for many subgroups in a population include: routine mammograms for women over 40, a fecal occult blood test for everyone over 50, an amniocentesis to rule out a fetal anomaly for pregnant women over 35, because the incidence of breast cancer and colon cancer in these subgroups is higher than in the general population, as is the incidence of Down’s syndrome in older mothers.

The testing of a person to rule out or confirm a suspected diagnosis because the patient has some sign or symptom is a diagnostic examination, not a screening. In these cases, the sign or symptom is used to explain the reason for the test.

A screening code may be a first listed code if the reason for the visit is specifically the screening exam. It may also be used as an additional code if the screening is done during an office visit for other health problems. A screening code is not necessary if the screening is inherent to a routine examination, such as a pap smear done during a routine pelvic examination.

Should a condition be discovered during the screening then the code for the condition may be assigned as an additional diagnosis.

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Oct 15th, 2010 -

on the other hand...

the recommendation for colonoscopy is every 10 years if normal and every 5 years if polyps found. If the test is done after 5 years and the screening code is again used, will CMS flag those doctors as overutilizers? There must be some way to designate that the testing interavl is medically indicated....

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Oct 15th, 2010 - jschmutz   323 

Screening Exams

This is my opinion, and perhaps there is information out there that states otherwise. But in my opinion, I feel that if it is truly a screening, it should be reported as such, even if that means that it isn't going to be paid.

For example, my insurance will only pay for a pap smear once a year (reported with V76.2) but if for some reason I want another pap smear a few months later and I have no signs/symptoms or reasons to get one other then I'm paranoid, this would still be reported as a screening and I would end up having to pay for the pap smear out of pocket.

CMS can recommend how often a screening exam SHOULD be performed, and CMS can state how often a screening exam will get paid, but they cannot state how often a screening exam CAN be performed. If the patient is aware that a screening is only going to be paid once every 5 or 10 years and they choose to have a screening done prior to that, then it should still be reported as a screening - it just won't be paid.

Again, this is my opinion only.

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Oct 15th, 2010 - rphelps 615  1 

hx of polyps vs screening colonoscopy

Medicare rule: Asymptomatic every 10 years High risk every 24 months

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Oct 18th, 2010 - drgo77 39 

hx of polyps vs screening colonoscopy

In pediatrics, we get requests from parents all the time to recode visits, particularly well exams. Depending on the insurance, a V20.2 is different from a V70.3. I usually don't mind changing the code. Where I draw the line is when the parent says "my insurance doesn't cover checkups, can you code it as an illness visit". At that point I politely say, the visit was booked as a well exam, the documentation is for a well exam, so billing is as a illness visit is fraud and I'm not going to change the code.

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Oct 26th, 2010 - mesalamb 26 

Need proof for the doctor

I need to bring this issue up again because the doctor is siding with our biller who says having polyps in the PAST means no more screening exams EVER.

I need some sort of proof which will back up my opinion that a screening is a screening no matter what happened in the past.

A patient that had polyps five years ago and comes back for a recheck and wants that billed as V76.51. I say that is okay, the other billers say it is not.

This issue is not really the guidelines for timing of screening exams. The issue is...does a history of polyps mean you can never have another colonoscopy coded as V76.51?

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Nov 9th, 2010 - koatsj 160 

hx of polyps vs screening

I was taught with regards to Medicare or any Medicare replacement policy, if the patient has no symptoms and is a high-risk patient (as in personal/family history of colonic polyps, personal/family history of colon cancer), you should use ICD-9 V76.51 and the high risk code with any other appropriate diagnoses found on endoscopy and use the appropriate CPT® code of G0105, G0121 or the colonscopy codes w/ biopsy that was used by the surgeon. I hope this helps you out.

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Nov 12th, 2010 - mesalamb 26 

There's the issue again...

koatsj just proved my point that there is not a clear answer on this issue.

Does a personal hx of polyps prevent you from having screenings?

Many of you have said that someone with a history of polyps with no symptoms still qualifies for a screening exam.

Others have said a history of polyps is a risk factor which qualifies you for a diagnostic exam only, even without symptoms.

I wish this was more clear...

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Nov 12th, 2010 - nmaguire   2,606 

colonoscopy

Some of the ICD-9 codes that Medicare carriers consider indicators of diagnoses of high risk in a patient - and therefore justify G0105 screenings - include V10.05 (Personal history of malignant neoplasm; gastrointestinal tract; large intestine), V12.72 (Personal history of certain other diseases; diseases of digestive system; colonic polyps), V16.0 (Family history of malignant neoplasm; gastrointestinal tract), V18.5 (Family history of certain other specific conditions; digestive disorders; colon polyps) and 555.0 (Regional enteritis of small intestine).

Because Medicare has no national determination for G0105, you should contact your Medicare local medical review policy (LMRP) to get its most recent list of approved diagnosis codes that identify patients at high risk of colorectal cancer.

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Nov 12th, 2010 - jschmutz   323 

Screening code for patient with history of breast cancer

When a patient has had breast cancer in the past, a screening mammo is still reported with V76.1x and V10.3

The fact that the patient has had breast cancer in the past has no bearing on whether a screening can be done again, or coded again. In fact, screenings are done again, and they are reported with a screening code AGAIN.

There is nothing in black and white that specifically states this because there is no reason to. If a screening is being done, then it needs to be reported as a screening. If a payer wants it reported differently, then fine, but according to the official guidelines, if a screening is being performed, then you use a screening code.

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May 11th, 2011 - shari14 1 

re: history of polyps vs. screening colonoscopy

I am coming into this late, but I did just see an article in "Briefings on APC" (HcPro publication, May 2011, Vol. 12, No. 5, pgs 11-12) that if it correct, implies that my facility's colonoscopy policy is not correct in it's use of V67.09, follow up.

I continue to get denials where the patient wants "screening", that is V76.51, coded for their colonoscopies. This article seems to agree with the patient's philosophy.

I am challenged when MDs state "screening" and also "previous polyp follow up" on the same account.

According to the article, after 5 years (following polypectomy), the scope should be considered screening. Personally, it would save me hassle.

I believe that coders at my sites are applying the V67.09 too much based on this article.

Shari Johns, RHIA, CCS

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