Hone Your Colonic Polyp Vocabulary with these two Tips

Find out how a pathology report can save your claim.

Remember that not all patients who present to the office with colon polyps will be diagnosed with colon cancer. This is the second-leading cause of cancer-related deaths in the United States and normally starts as small, benign adenomatous lump, and becomes cancerous overtime.

Colon cancer (colorectal cancer as it is regularly called) is a cancer which starts in the large bowel portion of the gastrointestinal (GI) system. Since it comes in many forms and symptoms, coding the definitive diagnosis might be risky. Safeguard your practice's deserved dollars with these three tips:

1. Do not go looking for 'benign', 'malignant'

Irrespective of whether or not you are 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 cover:

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 starting in the teenage years. If this is not treated, the patient becomes high risk to develop colon cancer.

Hereditary nonpolyposis colorectal cancer, a hereditary disorder that leads to an increased risk of developing colon cancer.

However first, you have to achieve the task of determining, without a doubt if a polyp is benign or malignant. If you think you'd find the clues in the pathology report (PR), think again. Normally, the PR will not use the term 'benign" or 'malignant'. But then it'll use a description that points to the usual behavior of the polyp. It is up to you to interpret those descriptions into benign or malignant.

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

2. Check with ICD-9 Neoplasm table

The ICD-9 codes Alphabetic Index to Diseases (Volume 2) features a neoplasm table where you can choose a definitive diagnosis code for a polyp. All diagnosis codes for neoplastic polyps -- and some non-neoplastic polyps -- will come from this table. Consider three things when choosing the right polyp code:

a) Body part. For malignant primary neoplastic polyps in the colon, you should look for the specific site of the colon which the doctor should mention in the procedure report.(I'e., traverse, sigmoid, ascending and descending).

For all other behaviors, the code descriptions make a general reference to the colon, large intestine or for that matter digestive system.

b) Behavior. In particular, behavior refers to the polyp's capacity to spread. If the polyp happens to be benign, it's noncancerous; of it is malignant, it's cancerous. A polyp can also be defined as 'uncertain' (235.2, Neoplasm of uncertain behavior of stomach, intestines and rectum) if its behavior is unpredictable and requires further investigation. On the contrary, an unspecified polyp (239.0, Neoplasm of unspecified nature of digestive system) needs to be determined further by lab tests.

c) Malignant polyp's nature. Further, you'd classify a malignant polyp into primary, secondary or in situ. A primary malignant colonic polyp (153.0-154.0) is one where the colon is the original site of the cancer. Secondary (197.5, Secondary malignant neoplasm of large intestine and rectum) means the cancer has metastasized from another site to the colon. An in situ malignant colonic polyp (230.3-230.4) is one where the cancer is remains confined to the colon.   Source URL  :- http://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/diagnosis-coding-2-tips-to-hone-your-colonic-polyp-vocabulary-106130-article

Same-Polyp Intervention? Turn to 45383 & 45381

As a gastroenterology coder, you may find yourself bowled over by coding situations such as these: The olympus scope was passed in the transverse colon. Outstanding prep. The lesion itself was at about 9 centimeter in the rectosigmoid or upper one third of the rectum really. With the rotatable snare, the base was encircled, and the polyp removed, and then one more small piece that was still on the wall was removed, thus, removing the entire lesion. This was retrieved, and put in a pathology bottle. After this, the area was re-examined. Since there was a diagnosis of dysplasia, it was elected to use the APC with 360 head post polypectomy setting which was done, and the entire area was APC'd under narrow band light. This was removed, the Argon removed, and then a tattoo was a SPOT material was used and photographs were clicked. As such, what codes should you use to report this procedure? Well, it appears the snare and APC intervention are on the same polyp/lesion. According to the report, the scope was passed only to the transverse colon; as such, if the procedure was planned as a sigmoidoscopy then you would use CPT codes from the flexible sigmoidoscopy family of codes even if the scope went beyond the splenic flexure. If the procedure was planned as a colonoscopy, then you should bill these codes on your claim:

For code 45383 - Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique.

For code 45381 -Colonoscopy, flexible, proximal to splenic flexture, with directed submucosal injection[s], any substance. You should not go for 45385 (Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique) as correct coding initiative edits bundle this code into 45383. The relative value units for 45385 (15.69 relative value units for non-facility) are lower than that for 45383 (16.72 relative value units for nonfacility); as such using the latter code will bring you more reimbursement: $568.09 (relative value units) multiplied by 2011 conversion factor of 33.9764). In this situation, you cannot unbundle the edit by using modifier 59 since interventions are on the same polyp. You'd bill the tattooing with 45381. For more on this and for other medical coding updates pertaining to gastroenterology coding, sign up for a good medical coding guide like http://supercoder.com/