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Surveillance Colonoscopy


Question

What would be the diagnoses and procedure codes for the following scenerio: A physician refers a Medicare patient for a "surveillance" colonoscopy due to a prior history of colon polyps which were removed and the patient has no symptoms. The colon was clear and nothing was seen or removed with this "surveillance" colonoscopy.

Answer

While Medicare does not use the term surveillance in the context of a colonoscopy, the American College of Gastroenterology equates a surveillance colonoscopy with a screening exam.  The term surveillance in ICD-9-CM indicates a condition that has been treated in the past and is no longer present but is being followed.  This, in combination with the fact that a screening exam is defined as an exam in a seemingly well individual with no presenting symptoms would tend to lead the coder to code this as a screening exam of a high risk patient if the Medicare G codes are being applied.  An appropriate V-code to capture the fact that the patient has a history of colon polyps will support the coding of the high-risk screening colonoscopy code.  If necessary, develop an internal policy that addresses the coding of surveillance colonoscopies as screening and/or work with physician staff to more clearly delineate these as screening.

Disclaimer: All articles intended for general consumption only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
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