Physician did a colonoscopy to sigmoid only because of previous resection. Then continued to four foot of small bowel. Is there a code that includes small bowel or is it separately billable as another code?
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Tag Archives: Colonoscopy
Colonoscopy screening; Z12.11
I recently coded a pathology report for a colonoscopy specimen (CPT 88305-26, DX Z12.11) which was denied payment by BCBS.
Pre-operative dx is: Screening for malignant neoplasm of colon.
In the report Gross description states:Specimen labeled, "colon polyp at 54cm." The specimen consist of tiny flecks of white material less than 1 mm. Collected in a tissue sack. All submitted.
Microscopic Description; Sample is crushed hemorrhagic colonic glands and stroma. There is no specific histological abnormality.
Final Pathological Diagnosis Large intestine, 54 cm, biopsy: No diagnostic alteration.
I’ve been asked by management to change the dx to D12.4 (Benign neoplasm of descending colon) and rebill the claim.
I don’t feel the diagnosis D12.4 is supported by the dictation in the report and am looking for some outside opinions.
Any input is welcome, thank you.
Colonoscopy screening; Z12.11
I recently coded a pathology report for a colonoscopy specimen (CPT 88305-26, DX Z12.11) which was denied payment by BCBS.
Pre-operative dx is: Screening for malignant neoplasm of colon.
In the report Gross description states:Specimen labeled, "colon polyp at 54cm." The specimen consist of tiny flecks of white material less than 1 mm. Collected in a tissue sack. All submitted.
Microscopic Description; Sample is crushed hemorrhagic colonic glands and stroma. There is no specific histological abnormality.
Final Pathological Diagnosis Large intestine, 54 cm, biopsy: No diagnostic alteration.
I’ve been asked by management to change the dx to D12.4 (Benign neoplasm of descending colon) and rebill the claim.
I don’t feel the diagnosis D12.4 is supported by the dictation in the report and am looking for some outside opinions.
Any input is welcome, thank you.
Screening Colonoscopy with Random Biopsy
Medicare patient in for screening colonoscopy, the physician documents doing a random biopsy that came back as benign mucosa.
Am I correct in thinking that this should still be coded as G0121? A "diagnostic colonoscopy with biopsy (45380)" is finding a lesion or polyp to biopsy for diagnostic reasons. Since there is no reason, but "random" biopsy, there is nothing to lead me to diagnostic. Therefore, still screening?
Thank you in advance.
office visit & colonoscopy coding
I need some advice with handling some of my more difficult scenerios.
When coding for Pre-visit and colonoscopy is a struggle. The surgeons I work for will sometimes state in the note recent history of symptoms and now the symptoms have resolved. Would those symptoms at the time of referral to the surgeon, pre-visit, or procedure determine whether the patient is symptomatic versus asymptomatic.
For example, I have a patient that was seen in the office that was referred with abdominal pain and blood in stool. The provider states that those symptoms have resolved. Would the recent symptoms be considered or is the patient now considered asymptomatic?
Also, on the visit will state screening colonoscopy but state patient has diarrhea or constipation. Then the Op note will only state that the indication is for screening. Is the office visit have any determining factor when your aware there is a contradiction?
Also, I’ve read when coding surveillance colonoscopies to code first Z08 or Z09 depending on the history diagnosis. Is that a recommended practice? I’ve always used my history code(reason for surveillance) as my primary code. Is this something that changed with ICD-10.
Thank you in advance for your time.
Melissa Stogsdill, CPC, CGSC
Office Visit BEFORE Colonoscopy with Dx of Personal History Of Colon Polyps
Someone (and I forget where I heard this) told me it is acceptable to use Z09 as primary dx code when a patient comes into office with dx of Personal History Of Colon Polyps before a colonoscopy in order to get the office visit paid for. So you would bill Z09 as primary code and Z86.010 as secondary code. Anyone know if this is correct?
Am I correct in not billing 45380 Colonoscopy bx with 45382 control of bleeding ???
This is my first time coming across this scenario so I appreciate feedback to know I am coding correctly. : )
Doctor provides CPT codes performed as 45380 Colonoscopy with biopsy and 45382 w/ control of bleeding.
His documentation states – FINDINGS: There was some mucosal inflammation and irregularity in the rectum. It was biopsied with cold biopsy forceps. After the biopsy, injection of hypertonic saline with epinephrine was performed to achieve hemostasis at the biopsy sites.
Since the control of bleeding was done at the same spot as the biopsies can I only bill for the 45380??
TIA
KAM
Dx Colonoscopy – EMR ( Endoscopic Mucosal Resection) Techniques
Hello!
I would greatly appreciate some help finding sources to clarify required verbiage in order to meet a 45390 for endoscopic mucosal resection. Our whole coding department is looking for some clarity as some of our providers tend to be vague case by case. My understanding is that AAPC recommends the lift, demarcate, piecemeal, and APC/cautery type description. I cannot seem to find this on AAPC or elsewhere (coding corner, ASGE, etc.) and I have not found clear answers for what might fall short. At times, depending on documentation, we are looking at a 45385, 45381-59 for the same lesion if it doesn’t quite meet the language we are looking for at this time. Any information or resources would be appreciated. Thanks!
I would greatly appreciate some help finding sources to clarify required verbiage in order to meet a 45390 for endoscopic mucosal resection. Our whole coding department is looking for some clarity as some of our providers tend to be vague case by case. My understanding is that AAPC recommends the lift, demarcate, piecemeal, and APC/cautery type description. I cannot seem to find this on AAPC or elsewhere (coding corner, ASGE, etc.) and I have not found clear answers for what might fall short. At times, depending on documentation, we are looking at a 45385, 45381-59 for the same lesion if it doesn’t quite meet the language we are looking for at this time. Any information or resources would be appreciated. Thanks!
Colonoscopy Diagnostic vs Preventative – What’s your Opinion
Hello Everyone,
I wanted to get other’s opinions on the much debatable issue of diagnostic versus preventative colonoscopy in my office. I have several providers within my office that like to order "screening" colonoscopies for the below scenarios.
1. Pt says they are here for a screening colon, first colon ever, but in the medical record physician documents symptomatic issues of constipation, rectal bleeding, diarrhea, etc. My provider feels that since the patient has not had a screening colon that they can order the procedure as such. I advise the provider that since the patient presented with symptoms then it is not a screening, per several articles I have found on the web from AAPC. How many other coders/billers have come across this issue and how did you handle this situation?
2. Patient comes in for screening colonoscopy. Provider documents that patient has "stable" chronic constipation. How would you code? In my opinion, patient has an issue and thus would be diagnostic, but the providers states that since it is stable it can be coded as a screening. Opinions?
Thank you all for your thoughts and opinions.
Screening Colonoscopy denials with PR-49
Is anyone else currently getting a denial from Medicare PR-49 for screening colonoscopies? We haven’t change the way we are billing and just recently our local MAC in FL is now denying and will not give us any guidance as to why other than to look at the denial code.