A Good Solution for Colonoscopy Confusion

There has been growing confusion over exactly how to report the growing number of colonoscopies that become “diagnostic”. This procedure has become more and more commonplace and the debate continues. Sometimes the best answer is the most obvious, contact the carrier and ask them how they want the procedure reported on your medical billing.

Colonoscopies are part of a check up for most individuals over the age of 50, however when the colonscopy finds a polyp, you should normally use the polyp diagnosis in your medical billing claim and not the screening V code. The exception to this rule would be if the physician discovers a polyp during the screening, you should instead report a diagnostic colonoscopy (45380, Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple).

The coding changes for a situation where the surgeon visualizes and biopsies the polyp, you should change the primary diagnosis from V76.51 (Special screening for malignant neoplasms; colon) to, for instance, 211.3 (Benign neoplasm of other parts of digestive system; colon).

The majority of carriers have states they want to switch the polyp diagnosis for the excision a few want to keep the V code. If you’re not sure in your medical billing, avoid a delay or rejection by asking what the carrier’s preference is.

View all Articles by: Melissa Clark, CCS-P