Sharpen Your Colonic Polyp Vocabulary With These Tips

Not all patients who present to the office with colon polyps will be diagnosed with colon cancer. This second-leading cause of cancer-related deaths in the US usually begins as small, benign adenomatous lump, and becomes cancerous overtime.

Colon cancer, or colorectal cancer as it’s regularly known, is a cancer which starts in the large bowel portion of the gastrointestinal (GI) system. Because it comes in many forms and symptoms, coding the definitive diagnosis might be risky. Guard your practice’s deserved dollars with these 3 tips.

1. Don’t Go Looking For ‘Benign’, ‘Malignant’

Whether or not you’re dealing with a full-blown colorectal cancer, you should be looking at the different terms used to describe benign or malignant colonic polyps. Some of these include:

  • Adenomas including tubular adenomas and tubulovillous adenomas
  • Hyperplastic polyps
  • Inflammatory polyps
  • Familial adenomatous polyposis, a rare hereditary disorder that causes hundreds of polyps in the lining of the colon beginning in the teenage years. If this is left untreated, the patient becomes high risk to develop colon cancer.
  • Hereditary nonpolyposis colorectal cancer, a hereditary disorder that causes an increased risk of developing colon cancer.

But first, you have to accomplish the task of determining — without a doubt — if a polyp is benign or malignant. If you think you would find the clues in the pathology report (PR), think again. Usually, the PR will not use the term “benign” or “malignant.” However, it will use a description that points to the usual behavior of the polyp. It’s up to you to interpret those descriptions into benign or malignant.

Experts advise that you always wait for the pathology report to come back before deciding on a particular ICD-9. Even the gastroenterologists, themselves, usually defer to the pathology report before making a recommendation.

2....

Comments Off on Sharpen Your Colonic Polyp Vocabulary With These Tips

Examine These FAQ to Sort Your Medicare Cancer Screen Codes

Remember frequency rules differ for average, high risk.

Getting Medicare to pony up for colorectal cancer screenings is not difficult provided you follow its frequency guidelines and eligibility requirements to the letter. A coding slip up on one of these items will knock you out of the saddle, and Medicare won’t accept the claim at all.

Rope in all the coding info you’ll need via this Medicare colorectal cancer screening FAQ.

Who’s Eligible for Average-Risk Test?

If the Medicare patient is 50-plus years old, he is eligible for a covered Medicare screening, confirms Dena Rumisek, CPC, biller at Michigan’s Grand River Gastroenterology PC.

However: These patients are considered average risk, and can have a colorectal cancer screening only once every 10 years, says Cheryl Ray, CCS, CPMA, of Atlantic Gastroenterology in Greenville, N.C. Ignore Medicare’s frequency guidelines at your peril, experts warn.

“Medicare is very stringent on the date … it has to be 10 years or longer — it can’t be 9 years and 360 days,” between covered screening colonoscopies, assures Rumisek.

Example: A 68-year-old established Medicare patient reports for a screening colonoscopy on Dec. 5, 2009. The patient’s records indicate that he last had a covered screening on Sept. 15, 1998. On the claim, you should report G0121 (Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk).

What ICD-9 Codes Are In Play for G0121?

Just one, provided there is no need for any therapeutic intervention during the colonoscopy. Medicare requires V76.51 (Special screening for malignant neoplasms; colon) on all G0121 claims. You might list other identified conditions secondarily, including diverticulosis (562.10) or hemorrhoids (455.0).

Always list the V code first for an average-risk screening, however.

What if the Patient Had a Recent Flexible Sig?

The frequency rules differ depending on whether other related...

Comments Off on Examine These FAQ to Sort Your Medicare Cancer Screen Codes

Gastro Coders: Be Aware of Medicare Screening Reqs Or Risk Payment Denial

Following 10-year-rule eliminates G0121 rejection.

If you slip up on screening colonoscopy claims’ frequency guidelines and eligibility requirements, Medicare will pay you zilch.

Use this guidance to capture every screening dollar your gastroenterologist deserves.

Home in on Eligibility Requirements for...

Comments Off on Gastro Coders: Be Aware of Medicare Screening Reqs Or Risk Payment Denial

CMS Will Cover HIV Screening As Preventive Care Service

Bonus: Effective immediately! You’re probably accustomed to CMS taking away coverage for certain services, but in an early holiday gift to practices, CMS has actually added a preventive care service to its roster of covered screenings, effective immediately. CMS issued a final decision on Dec. 8 declaring that HIV testing will now be covered for Medicare beneficiaries [...] Related articles:

  1. Show Us the Money for Primary CareAlmost everyone agrees that federal and private insurers should reimburse...
  2. Colorectal Cancer Screening: A Medicare Coding & Billing FAQ Steer clear of G0121 denials with these tips. If...
  3. Good-Bye Fee-For-Service, Hello ‘Episodes of Care’It’s not like we’re going to go back to capitation...

Comments Off on CMS Will Cover HIV Screening As Preventive Care Service

Celebrate CT Colonography’s 2010 Move to Category I

But don’t assume the new codes will yield improved fees. Virtual colonoscopy coverage may be a mixed bag, but the AMA showed some confidence in the service by moving its codes from temporary Category III status to full-fledged Category I in 2010. The switch from Category III to Category I does offer some hope of better reimbursement [...] Related articles:

  1. New CPT Codes for Cardiac CT, Imaging Appear for 2010Plus: Say goodbye to two perfusion codes. If you’ve ever...
  2. Virtual Colonoscopy Reimbursement: Still ‘Virtual’ For Now Many cancer clinicians are all for virtual colonoscopy because...
  3. Don’t Wait for CPT: Maximize Virtual Colonoscopy Payment Now Learn whether to file an ABN with 0066T, 0067T....

Comments Off on Celebrate CT Colonography’s 2010 Move to Category I