Q&A: Colonoscopy coding

April 19, 2011

QUESTION: Colonoscopy coding can be a nightmare at times because hospital coding and the physician office coding do not match.

Here's an example. The patient had a colonoscopy five years ago with history of polyps found. The hospital coding will be code V76.51 (Special screening for malignant neoplasms of the colon [screening colonoscopy not otherwise specified]) as primary because it has been five years and code V12.72 (Colonic polyps) secondary.

We would use the screening G code G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) for low risk since the provider did not classify the polyps as adenomatous. The physician's office is coding V12.72 as the primary diagnosis along with the diagnostic CPT® code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen[s] by brushing or washing, with or without colon decompression). Please provide any assistance and references.

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