Coding a Screening Colonoscopy

Question: If a patient is referred to our office for a screening colonoscopy and she is asymptomatic, how should we code this encounter?

Answer: Let me make sure I have this right: The patient comes in, is asymptomatic, but needs a screening colonoscopy just because she is at normal risk and you are coding for the colonoscopy. Correct? If so, use ICD-9 V76.51, Special screening for malignant neoplasm, colon, as the first diagnosis code. Then CPT 45378, Colonoscopy, flexible, proximal to splenic flexure, diagnostic (assuming a non-Medicare patient).

If, however, you are asking about getting paid for a visit before the procedure, Medicare and most other payers typically won’t pay for E&M visits on the day of or the day prior to surgery unless that is the visit that led to the decision for surgery. Some payers extend this to 30 days.

What is relevant here is whether the physician needs to see the patient to determine the need for the procedure or if the procedure is why the patient was referred in the first place.

If your physician is doing the E&M visit to evaluate and diagnose the patient and then decides to do the colonoscopy, he should get paid. For the ICD-9, then, you would code the condition the patient came in for.