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V72.83 - QUESTION

Melanie Posted Tue 06th of April, 2010 15:01:18 PM

Hello!
I have a patient that underwent a colonoscopy screen - physician indicates that the intent was for "screen prior to liver transplant" -

would the primary diag be classified as v72.83?

SuperCoder Answered Wed 07th of April, 2010 07:38:45 AM

As per Medicare a person falling under the High risk category is eligible for a colon cancer screening once every 2 years. Where as a person falling under low risk is eligible for once every 10 years. But in this case the scenario is something different because a screening CPT code supports a very limited diagnosis like history of colon/rectum cancer, liver, polyp, family history of cancer or a surgical followup. But I don't think a screening prior to liver transplant is not eligible for a screening CPT code. So in this case you need to determine the reason for liver transplant and bill accordingly.
Also do check your LCD and the Medicare preventive service guide (http://www.supercoder.com/cms/mln-specialty-book/medicare-preventive-services-3/)

Melanie Posted Thu 08th of April, 2010 12:48:02 PM

I do check the LCD's prior to posting so please understand..... its usually rare cases like this or if Im looking for further clarification of a code is when Ill post a request for help while I await for dictation to arrive. I assure you I dont require hand-holding... Its not often a patient comes in requiring a colonoscopy prior to a liver transplant...

Was just hoping for a little help 8-)

SuperCoder Answered Fri 09th of April, 2010 10:15:42 AM

Did some extra digging and found out that Medicare do accepts V72.83 for screening low risk and it can be used as primary or secondary diagnosis. Also mention about the current condition of liver and if possible do post about the dx provided.

Melanie Posted Fri 09th of April, 2010 13:32:49 PM

Just found some FASCINATING information pertaining to pre-operative services for liver transplant-eligible patients... Thanks to a contact from Johns Hopkins, they have a great page of information pertaining to the requirements from UNOS. http://www.hopkinsmedicine.org/transplant/Programs/liver/liver_candidates

Our patient has congenital Polycystic Liver Disease and Polycystic Kidney Disease.

The V72.83 would be her primary diagnosis/purpose of the colon.
The 751.62 - the code for her PLD would be secondary and the indicator of an 'add-on' code because we did not diagnose her with it, but it complements the primary diag's purpose.

Figured I would share this site in case anyone else runs into this (hopefully they dont, but Im sure you know what I mean)

- I have never never never ever had a transplant-eligible patient before in all of my 15 years of doing this - this brought tears to my eyes because I know how difficult it is for organ-recipients to finally get the organ thay need....

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