Forum - Questions & Answers

May 28th, 2015 - reetown3 5 

??? Coding dx codes from op note

Scenario: 65 year old Medicare patient has very 1st Screening Colonoscopy.
Scope went to the ileocecal valve. Prep was excellent, patient tolerated procedure.

Finding: Diverticulosis was found throughout the entire colon, no biopsies done at this time.

I coded as follow

CPT® code G0121 (no modifier)

Primary Dx :V76.51
Secondary DX: 562.10

Please review and advise. I was told it was incorrect because Medicare will not process claim as screening, because of the secondary dx code. I was told not to code any incidental findings. However, I disagree. Please advise.

May 29th, 2015 - lhudson 47 

re: ??? CODING DX CODES FROM OP NOTE

I would say your coding is correct. Medicare and all other insurances will take the first dx as the one to go with the procedure code. As you probably already know that if there had been any biopsies, then you would have had to submit the proper CPT® code and apply the PT modifier for Medicare to show this was a screening. Your primary dx would still be the V76.51 with the polyp as secondary.

May 29th, 2015 - reetown3 5 

re: ??? CODING DX CODES FROM OP NOTE

Good morning. Thank you for your help. I have another one.

Scenerio: Medicare patient had colonoscopy for indication of IDA.
Scope was introduced and advanced to ileocecal valve. Prep was excellent.

Impression: Diverticulosis in the sigmoid colon, no bx was taken at this time.

I coded:

45378( no modifier)

Primary dx code: 562.10

I was told that was incorrect and I only should have coded the IDA 280.9. I disagree, those were his findings. Thanks again, please have a wonderful day.

May 29th, 2015 -

re: ??? CODING DX CODES FROM OP NOTE

The Medicare code for a screening colon in G0121 for low risk pts. Medicare is no longer recognizing the 45378 code.



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