CPT coding guidelines of colonoscopy / Digestive coding

 

           COLONOSCOPY

Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include examination of the terminal ileum or small intestine proximal to an anastomosis.

 CPT code based on the approach

1.  Colonoscopy through a stoma (44388 - 44408)

Colonoscopy through stoma the examination of the colon, from the colostomy stoma to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis. a patient who has undergone segmental resection of the colon (eg, hemicolectomy, sigmoid colectomy, low anterior resection) and has a colostomy.

1. Colonoscopy  through natural orifice (Anus ): 45378 – 45398

Colonoscopy is the examination of the entire colon, from the rectum to the cecum, and may include examination of the terminal ileum or small intestine proximal to an anastomosis

What are the  Types of colonoscopy:

1. Screening colonoscopy
2. Diagnostic colonoscopy
3. Therapeutic colonoscopy
4. Surveillance colonoscopy

1. What is Screening colonoscopy

CPT coding guidelines of colonoscopy  Screening colonoscopy is provided to a patient in the absence of signs or symptoms based on the patient’s age, gender, medical history, and family history according to medical guidelines. It is defined by the population on which the test is performed, not the results or findings of the test. As such, “screening” describes a colonoscopy that is routinely performed on an asymptomatic person for the purpose of testing for the presence of colorectal cancer or colorectal polyps.

1.  What is Diagnostic colonoscopy

Diagnostic colonoscopy is performed when the patient has physical symptoms such as rectal bleeding or pain and the test is necessary to either rule out or confirm a suspected condition. Signs and symptoms are used to explain the reason for the test.

1. What is Therapeutic colonoscopy

Therapeutic colonoscopy is performed when the abnormalities are treated for the purpose of biopsy, tumor ablation, or other therapy.

1. What is Surveillance colonoscopy

Surveillance colonoscopy is when the patient is asymptomatic but has a personal history of gastrointestinal disease, colon polyps, or cancer. Technically, this is a screening test with different diagnostic coding and frequency guidelines.

 Guidelines for screening colonoscopy:

 CPT coding guidelines of colonoscopy ( Advantages of accuracy coding)

For commercial and Medicaid patients, report CPT® code 45378 Colonoscopy, flexible; diagnostic, including collection of specimens(s) by brushing or washing, when performed (separate procedure)

· For Medicare patients, report HCPCS Level II code G0105 Colorectal cancer screening; colonoscopy on individual at high risk or G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk


·    Append PT modifier indicates a screening colonoscopy has been converted to a diagnostic test or other procedure

·    Screening converted to diagnostic or therapeutic procedure code from 45378 – 45398 with PT modifier

How to consider high risk?

·         A personal history of adenomatous polyps, colorectal cancer, or inflammatory bowel disease, including Crohn’s disease and ulcerative colitis; and/or

·         A family history of familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer or a close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp.

ICD-10-CM coding for screening colonoscopy: to avoid error

·    Z12  - Encounter for screening for malignant neoplasm of colon

·    Z80.0 - Family history of malignant neoplasm of digestive organs

 What is the Coding guidelines Diagnostic colonoscopy

When bleeding occurs as the result of an endoscopic procedure, control of bleeding is not reported separately during the same operative session

   a.Hematochezia not thought to be from rectum or perianal source
b. Melena of unknown origin
c. Presence of fecal occult blood
d. For unexplained iron deficiency anemia

Should be coded as CPT code from 45378

What is the Coding guidelines for Therapeutic colonoscopy to improve coding knowledge

 

 

Diagnostic colonoscopy:

·    If Patient came for Diagnostic procedure but does not reach splenic flexure code 45330 Flexible sigmoidoscopy.

·    If patient came for diagnostic procedure scopy beyond the splenic flexure but not to the cecum should be coded CPT code 45378 with 53 modifier.

·    Colonoscopy complete to the cecum code 45378 no modifier required.

Therapeutic colonoscopy:

•      If Patient came for Diagnostic procedure but does not reach splenic flexure code 45331-45347

•      If patient came for diagnostic procedure scopy beyond the splenic flexure but not to the cecum should be coded CPT code 45379-45398-52

•      Colonoscopy complete to the cecum code 45379-45398 no modifier required

For surveillance of colonic neoplasia

a.               For examination to evaluate the entire colon for synchronous cancer or polyps in a patient with treatable cancer or polyps.

b.               For follow-up 1 year after surgery for treatment of colorectal cancer when the patient is identified as being at high-risk for colon cancer and is eligible for continued screenings at 24-month intervals.

c.               For follow-up at least 3-6 months after colonoscopic removal of a large sessile adenoma (i.e., greater than 2 cm in greatest dimension).

d.               For patients with Crohn’s colitis, chronic ulcerative colitis (UC), pancolitis of greater than 7 years duration or left-sided colitis of over 15 years duration (no surveillance needed for disease limited to rectosigmoid) may have a colonoscopy every 1-2 years for multiple biopsies to detect cancer and/or dysplasia.

When a diagnostic colonoscopy, sigmoidoscopy or proctosigmoidoscopy is performed and the findings are normal, or did not provide a diagnosis, please report the symptom(s) for which the endoscopy was performed

What are the Types of polypectomy technique

1.       Hot  technique (45384)

2.       snare technique (45385)

3.       Cold biopsy technique  (45380)

 Polypectomy coding guidelines:

 

• ·    Single polyp with different technique may be coded only extensive technique
• ·    Multiple poly removed with different technique code all technique with 59 or XS modifier
•      Sequence the different type of technique based on the extensive method of polypectomy.