Coding Colonoscopies

I have questions about coding Outpatient colonoscopies.

1) If the physician performing the colonoscopy states the indication for the procedure is "Screening with past personal history of Colon Ca". What is/are the correct ICD-9-CM diagnosis code(s) to assign?

2) If the physician states the patient is presenting for a screening colonoscopy and then lists signs and symptoms (i.e. blood in stool, abdominal pain, chronic diarrhea, etc.) OR states Screening for Abdominal pain, blood in stool, chronic dianrrhea and schedules the patient for a screening colonoscopy. Should V76.51 Screening for malignant neoplasm of colon be assigned as the primary diagnosis OR should the coder assign the signs and symptoms coding a diagnostic colonoscopy?

Please note we are not able to query the physician. These are on Outpatient charts.



Thank you.

re: Coding Colonoscopies

1. If there was nothing found on colonoscopy, I would code it as V76.51 & V10.05.
2. If there are payable symptoms, code the symptoms. If there is something found, code what is found.

re: Coding Colonoscopies

Ask the physician to use the word "screening" when the patient is having the procedure because the USPTF recommends it due to their age/history/family history, but the patient has no symptoms or indications for the procedure.

Ask the physician to use the word "diagnostic" when the patient presents with symptoms: bleeding and anemia, for example, and the procedure is being done to investigate the patient's complaints.

That will help you to select the right CPT/HCPCS code, the right ICD-9 code, and apply modifiers.

re: Coding Colonoscopies

We code all colonoscopies with the reason they are having it done. If the patient is requesting a screening with no signs or symptoms we will bill with V76.51 and if the doctor finds something then those dx's will go second and third and so on. If a patient presents with symptoms, then that is not considered a screening.