Donna SanGiovanni, CPC, CASCC, CHI, a former member of AAPC's National Advisory Board and a clinical practice specialist in the Department of Digestive Diseases at Yale University, recently discussed the proper way to code a screening colonoscopy in ADVANCE for Health Information Professionals.
Ms. SanGiovanni, first discussed the definition of a screening colonoscopy. She explained that physicians typically suggest a colorectal cancer screening when a healthy patient turns 50. The procedure involves inserting a colonoscope into the anus and moving through the colon, past the splenic flexure, to visualize the lumen of the rectum and the colon.
According to Ms. SanGiovanni, the diagnosis code is selected from the V code section V76.51. The CPT code is 45378 (Colonoscopy, flexible, proximal to splenic flexure, diagnostic). For Medicare patients, coders should report V76.51 as the primary diagnosis, then check if the patient is "high risk," based on various factors found on the CMS list. Starting Jan. 1, 2011, if a patient presents for a screening colonoscopy, Medicare will waive the deductible and co-insurance.
If the provider finds a polyp and performs a polypectomy during the screening, the primary diagnosis would be V76.51 and the polyp would be included as secondary. The procedure code depends on the technique to remove the polyps — for example, for a biopsy technique, the code would be 45380, but for a snare technique, the code would be 45385. Modifier -22 is used when "many" polyps are removed, though Ms. SanGiovanni says there is "no magic number of polyps" needed to use the modifier.
An incomplete colonoscopy, in which the colonoscope does not pass the splenic flexure, should be coded as a colonoscopy with a 53 modifier.
Read the ADVANCE for Health Information Professionals report on coding colonoscopies.
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Ms. SanGiovanni, first discussed the definition of a screening colonoscopy. She explained that physicians typically suggest a colorectal cancer screening when a healthy patient turns 50. The procedure involves inserting a colonoscope into the anus and moving through the colon, past the splenic flexure, to visualize the lumen of the rectum and the colon.
According to Ms. SanGiovanni, the diagnosis code is selected from the V code section V76.51. The CPT code is 45378 (Colonoscopy, flexible, proximal to splenic flexure, diagnostic). For Medicare patients, coders should report V76.51 as the primary diagnosis, then check if the patient is "high risk," based on various factors found on the CMS list. Starting Jan. 1, 2011, if a patient presents for a screening colonoscopy, Medicare will waive the deductible and co-insurance.
If the provider finds a polyp and performs a polypectomy during the screening, the primary diagnosis would be V76.51 and the polyp would be included as secondary. The procedure code depends on the technique to remove the polyps — for example, for a biopsy technique, the code would be 45380, but for a snare technique, the code would be 45385. Modifier -22 is used when "many" polyps are removed, though Ms. SanGiovanni says there is "no magic number of polyps" needed to use the modifier.
An incomplete colonoscopy, in which the colonoscope does not pass the splenic flexure, should be coded as a colonoscopy with a 53 modifier.
Read the ADVANCE for Health Information Professionals report on coding colonoscopies.
Related Articles on Coding, Billing and Collections:
5 Ways Cash Payments for Spine Help the Patient and the ASC
Managing the Revenue Cycle: 10 Areas for Improvement
Medical Management Professionals EVP: Physician Practices Must Prepare for ICD-10