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Screenings for established patient w//crohns

Susan Posted Thu 21st of November, 2013 11:19:43 AM

Crohns patients are eligible for screenings due to high risk of colon cancer per medicare and other private insurers.Since the procedure would be a screening would it be appropriate to use V76.51 as primary and the crohns as the secondary dx? If we used the crohns as primary I don't think the payers would recognize as a screening and pay accordingly....what do you suggest we use to get these screenings billed and paid?

SuperCoder Answered Thu 21st of November, 2013 19:56:44 PM

You should support G0105 for high-risk patients with selected diagnoses, including:

V10.05 -- Personal history of malignant neoplasm; gastrointestinal tract; large intestine
V10.06 -- Personal history of malignant neoplasm, rectum, rectosigmoid junction, and anus
V12.72 -- Personal history of certain other diseases; diseases of digestive system; colonic polyps
V16.0 -- Family history of malignant neoplasm; gastrointestinal tract
V18.51 -- Family history, colonic polyp Family history of certain other specific conditions; digestive disorders (colon polyps)
Medicare also allows inflammatory bowel diseases, Crohn's disease (555.x, Regional enteritis) or ulcerative colitis (556, Ulcerative eterocolitis), as primary diagnosis for G0105.

SuperCoder Answered Thu 21st of November, 2013 19:57:56 PM

Yes, first code 'V76.51' and then crohns as the secondary diagnosis.

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