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Diagnostic/Screening Colonoscopy

Nancy Posted Mon 22nd of March, 2010 19:54:11 PM

I hate to beat a dead horse as the old saying goes, but I need some help. This pertains to commerical insurance. If a patient had a screening colonoscopy in 2003 and a polyp was found but not by one of our GI doctors. I know it was billed as a colonoscopy with polypectomy with dx V76.51 and colon polyp dx 211.3. In 2005 pt came back and had another diagnostic colonoscopy because they had hematochezia and hx of colon polyp but the colonoscopy showed internal/external hemorrhoids. Now the patient is returning for another colonscopy with no symptoms but hx of colon polyp, can this be billed with dx V76.51 & V12.72 or is it only billed with V12.72. Pt's insurance is stating since it has been more than 7 years since a polyp was found that it can be billed as a screening. Is this correct because the patient is very upset with the way her benefits are being verified? Please help.

SuperCoder Answered Tue 23rd of March, 2010 06:54:14 AM

Since the patient has history of colonic polyp, so it falls under the category of High risk. As per Medicare a person falling under the High risk category is eligible for a screening exam once every 2 years. Where as a person falling under low risk is eligible for once every 10 years. So in this I can say that the patient eligible for a screening.

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