Cracking the Code

Medicare Screening Colonoscopy Becomes Diagnostic

It is very important for outpatient coders to understand how to correctly code screening colonoscopy encounters, especially for Medicare. Screening colonoscopies are the key to preventing colorectal cancer or detecting it early. Sometimes, these screenings become diagnostic procedures when colon polyps are removed during the process. When a patient presents for a screening, it is appropriate to assign the screening code as the primary diagnosis. All findings are reported as secondary diagnosis codes. For Medicare patients, modifier PT should be assigned to the appropriate CPT code to indicate that a colonoscopy was scheduled as a screening but converted to a diagnostic procedure. Coders must ensure they follow this guidance to prevent unnecessary denials and capture the information as accurately as possible for that patient.

Q: A 50-year-old Medicare patient with a family history of colon cancer presents for a colonoscopy screening. The physician finds a colon polyp in the sigmoid colon and removes it via snare polypectomy. Patient tolerates the procedure well. Pathology report states that the polyp was benign.
A: Z12.11, encounter for screening for malignant neoplasm of the colon
D12.5, benign neoplasm of sigmoid colon
Z80.0, family history of malignant neoplasm of digestive organs
CPT 45385-PT, Colonoscopy with removal of polyp by snare
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