Colonoscopy as follow-up

Pt scheduled for screening colonoscopy--polyp found and removed. Goes home happy. Now he is at high risk since he has a history of colonic polyps. The next time he comes in for the scheduled colonoscopy (not having any problems), there are no polyps found. Is this visit considered a follow-up to the first visit, or is it considered another screening?

Under the above circumstances, isn't the ORIGINAL INTENT of the screening colonoscopy, screening for cancer? Isn't the rest of the screening colonoscopies that follow considered as screening for polyps (which would make it a follow-up encounter)--or does it continue to be thought of as a screening for cancer?

re: Colonoscopy as follow-up

Sounds like: V67.59 and V12.72

re: Colonoscopy as follow-up

So you are saying that the encounter would then be considered as a follow-up henceforth, right? No matter when the future colonoscopies are done, it is always considered as a follow-up to the first encounter where they found the initial polyps, it can never be a screening again, right?

This would then mean that the "follow-up" V67.59 code reflects that since the first encounter identified non-malignant polyps, the future follow-ups are to ensure the patient (that is at high risk henceforth) in the future has polyps that remain non-malignant--right?

But, isn't this a screening--or is it not possible for a high risk patient to undergo a SCREENING colonoscopy with no findings?

Diagnostic code: V67.09, V12.72 (CPT) Procedure code: 45378 OR
V76.51, V12.72 (CPT) Procedure code: G0105 ?

I truly appreciate your point of view on this issue. It has been driving me nuts.

re: Colonoscopy as follow-up

Many payers state that patients with a history of polyps will be considered surveillance and processed under med necc benefits instead of screening. There is actually several notes in the Affordable Care Act regarding colonoscopy screenings stating that patients with a personal history of cancer and/or adenomatous polyps are not covered as screenings.
Screening Colonoscopy is an investigation or testing the patients with a scope who currently has no symptoms but are at high risk for colon / rectal cancer and / or any other abnormality of the Intestinal tract. A screening colonoscopy is used to identify and remove polyps in its precancerous stage before it develops to a cancer. The high risk persons are those with a family / personal history of colon polyps and patients with Inflammatory Bowel disease. The codes in question:
V76.51 Screening for malignant neoplasm, colon
V67.09 Follow-up examination following other surgery
V12.72 Personal history of colonic polyps.
Your question's answer is based on payer guidelines and interpretation. Look at: https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/Colonoscopy_Apr_11.pdf

re: Colonoscopy as follow-up

OK--all 3 diagnostic codes, right?

Which procedure code:
(CPT) Procedure code: 45378 OR (CPT) Procedure code: G0105?
I am going to present this opinion at a meeting. I will post the outcome.

re: Colonoscopy as follow-up

For Medicare, I would use high risk screening, so the HCPCS code.

For commercial insurance the CPT® code.

re: Colonoscopy as follow-up

Not all 3 codes. According to the US Preventive Services Task Force, “Individuals with a personal history of cancer or adenomatous polyps are followed by a surveillance regimen, and screening guidelines are not applicable. The point is that code assignment must be based on the physician’s documentation regarding the reason for the procedure. If the documentation is not clear or if it contains conflicting information, seek clarification from the provider regarding what procedure was performed.
According to the ICD-9-CM Official Guidelines for Coding and Reporting, “The follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists… Code assignment must be based on documentation by the physician regarding the reason for the procedure. Follow official coding guidelines regarding screening and surveillance colonoscopy and follow payer policies on coding and billing for colonoscopy.
Medicare considers a person at high risk of developing colorectal cancer if a person has one or more of the following risk factors:
• A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp;
• A family history of familial adenomatous polyposis
• A family history of hereditary nonpolyposis colorectal cancer
• A personal history of adenomatous polyps
• A personal history of colorectal cancer; or
• A personal history of inflammatory bowel disease, including Crohn’s disease and ulcerative colitis.
In the scenario where a patient with a history of colon polyps underwent a colonoscopy, absent signs and symptoms, it should not be assumed that the patient underwent a screening colonoscopy.
“The follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists."

re: Colonoscopy as follow-up

Thanks so much for the input. You have confirmed my position so I will present it.